Term
| 4 types of Generalized Erythema: |
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Definition
- Drug Eruptions
- Viral Exanthems
- Toxic Erythema
- Systemic Lupus Erythematosis |
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Term
| Drugs that commonly cause drug eruptions: |
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Definition
- antibiotics
- diuretics
- NSAIDs
- anti-hypertensive medications
- anti-seizure medications
- prescription pain medications |
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Term
| ___ rashes and ___ reactions are the most common drug eruptions. However, __ and ___ can also occur. |
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Definition
- Morbilliform rashes (measles like rash)
- Urticarial reactions
- vesicles
- photodermatitis |
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Term
| Antibiotics that commonly cause drug reactions: |
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Definition
- penicillin
- Sulfas
- Cephalosporin |
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Term
| ___ cause photosensitivity drug eruptions. |
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Definition
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Term
| NSAIDs tend to cause __ drug eruptions or __. |
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Definition
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Term
| __ and __ are most common drug causes of Stevens-Johnson Syndrome aka __ __ __. This has mucocutaneous involvement and a 20% mortality rate. |
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Definition
- Antibiotics and Anticonvuslants
- Erythema Multiforme Major |
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Term
| When drug eruptions occur, do a __ biopsy and send to a ___. Communicate with the physician who prescribed the suspected drug before stopping any medication. Recommend one drug be stopped at a time for 4-6 weeks to see if rash resolves. |
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Definition
- punch biopsy
- dermatopathologist |
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Term
| Therapy for drug eruptions: |
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Definition
- Discontinue offending drug
- Antihistamines for pruritis
- Prednisone short course if necessary, taper down
- Moisturizers to reduce infection
- Oral/topical antibiotics is suspect secondary infection from scratching |
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Term
| If someone has a pruritic rash, __ __ must be in differential. |
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Definition
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Term
| Viral Exanthems are rashes from __ __ __. Vaccinations are important for reducing epidemics (MMR). Usually preceeded by a __ of fever and constitutional symptoms. |
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Definition
- common childhood diseases
- prodrome |
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Term
| Measles aka ___ has a prodrome of __, __ (aka __ __), and ___. Patient will also have had __, __, and __. The rash begins _ to _ days after prodrome and lasts for __ __. |
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Definition
- Rubeola
- cough
- coryza (aka head cold)
- conjunctivitis
- fever
- fatigue
- arthralgias
- 3-4 days
- one week |
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Term
| Patients with German Measles aka __ will have __ __ and __ __ __. The __ rash starts on the __ and works __. The rash lasts __ __ hence the term __ __ measles. |
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Definition
- Rubella
- mild fever and tender cervical lymphadenopathy
- pruritic rash
- face
- downward
- last 3 days
- 3 day measles |
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Term
| Herpes Virus Type 6 aka __ ___ aka __ __ occurs in children from __ months to __ years. It is caused by HSV __ or __. Patient will have a __ __ for __to __ _, __ __, and ___. |
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Definition
- Roseola infantum
- Sixth Disease
- 6 months to 2 years
- HSV 6 or 7
- high fever for 3-5 days
- runny nose
- diarrhea |
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Term
| __ __ aka Fifth's Disease is caused by __ __. It has a __ prodromal phase of __, __ _ fever, __, and __. After prodrome, patient gets a red __ __ appearance, followed by a ___ (aka __ _) erythema on the __ and __ __. This is a common misdiagnosis by school nurses. |
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Definition
- Erythema Infectiosum
- parvovirus B19
- mild prodromal phase
- headache, low grade fever, arthralgias, and pharyngitis
- red "slapped cheek" appearance
- reticular (net-like) erythema on trunk and proximal extremities |
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Term
| Child comes in with diffuse rash. 4 days ago he had a cough, red eyes, and a cold. What is your diagnosis? How long do you tell the parent the rash will last? |
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Definition
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Term
| Child comes in with a pruritic rash on their face. You palpate tender swollen cervical lymphnodes and note a mild fever. What is your diagnosis? How long do you tell the parent the rash will last? |
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Definition
German Measles aka Rubella
3 days |
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Term
| 18 month child is brought in with a runny nose, diarrhea, diffuse rash, and high fever. What is your dx and what do you tell the parents the cause of this is? |
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Definition
- Roseola Infantum aka Sixth Disease
- HSV 6 or 7 |
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Term
| Child is brought in with hx of headache, arthralgia, low grade fever, and pharyngitis. You notice a net like rash on the upper thighs and upper arms. What is your diagnosis? What do also probably see on his/her face? What is the cause of this condition? |
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Definition
- Erythema Infectiousum aka Fifth Disease
- red slapped cheek appearance
- parvovirus B18 |
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Term
| When a kid comes in with the slapped cheek appearance of __ __, you tell the parent that the kid is contagious or not contagious. |
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Definition
Erythema Infectiosum aka Fifth Disease
not contagious (rash appears after child already feels better and is no longer contagious) |
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Term
| Hand-Foot-Mouth Disease is most commonly caused by __ __. It begins with __, __ _, and ___. Painful sores in the __ begin at __ days and become ulcers. Then a ___ rash appears on the hands and feet starting at day 1 or 2, vesicles may form. |
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Definition
- Coxsackievirus A16
- fever, sore throat, malaise
- mouth begin at 2 days
- non-pruritic rash |
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Term
| Toxic erythemas are usually caused by __ __ or ___ infections. |
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Definition
- Staph aureus
- Streptococcal infections |
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Term
| You see a patient with a red sandpapery rash that is accentuated in the flexural folds with desquamation. Mucus membranes are also involved (but not always). What is your general Dx? |
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Definition
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Term
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Definition
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Term
| __ __ aka Scarlatina is a __ erythema caused by __ _ __. The rash begins on the __ and __, then spreads to the __, __, and __. This rash lasts __ to __ __. There is often __ of the hands and feet. Patients will have a __ __, __, __, __, __ __and arthralgias. This is worse in adults. Upon examination of the mouth you will see a __ tongue. |
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Definition
- Scarlet Fever
- toxic erythema
- group A strep
- begins on the chest and abdomen
- spreads to the neck, face, and extremities
- 2 to 7 days
- desquamation of the hands and feet
- sore throat, nausea, vomiting, headache, cervical lymphadenopathy and arthralgias
- strawberry tongue |
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Term
| With Scarlet Fever, the desquamation of skin begins when the child is still feeling ill or when they are feeling better? |
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Definition
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Term
| Staphylococcal Scalded Skin Syndrome (SSSS) is a __ __ infection. __ are at a high risk. Give patient __ __ asap. |
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Definition
- Staph aureus infection
- Neonates
- IV antibiotics |
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Term
| Toxic Shock Syndrome is a __ __ infection. From 1979 to 1982 it was due to superabsorbant tampons. Now it is due to infections in __, __, __ __, or __ packing. |
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Definition
- Staph aureus
- infections in wounds
- catheters
- contraceptive diaphragms
- nasal packing |
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Term
| A patient with Toxic Shock Syndrome will be __ and will have a __ __ eruption with __ 1 to 2 weeks after onset. They will have __. They will have clinical or laboratory abnormalities of at least __ systems since this is a multisystem illness. They will have absense of other causes of illness. These patients go into widespread __ and look like patients with SSSS. |
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Definition
- febrile
- widespread macular eruption with desquamation
- hypotension
- three systems
- widespread DIC |
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Term
| Kawasaki syndrome is aka __ __ __ syndrome b/c of its effects on __ __ and __ __. |
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Definition
- Mucocutaneous lymph node syndrome
- lymph nodes
- mucus membranes |
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Term
You see a patient with:
- High fever
- Conjunctivitis
- Red Palms
- Red soles
- Desquamation in diaper area
- Exanthem on trunk
- Cherry red lips
- Strawberry tongue
What is your Dx? |
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Definition
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Term
| Exanthem associated with Kawasaki syndrome is __ __ often around the knees and flexural folds that are not that __. |
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Definition
- red plaques
- not that scaly |
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Term
| The cause of Kawasaki syndrome is __. It is associated with __ age group. |
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Definition
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Term
| With Kawasaki Syndrome there is ____ that increases one's risk of __ __ aneurysm. This occurs in 20% of patients with this syndrome and can be delayed for 1 year or more after acute episode. |
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Definition
- thrombocytosis
- coronary artery aneurysm |
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Term
| The biggest worry with Kawaski syndrome is __ __ __, thus these patients need to see a __. |
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Definition
- coronary artery aneurysm
- cardiologist |
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Term
| Kawasaki Syndrome treatment: |
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Definition
- Antibiotics if infection found
- Aspirin
- Gamma Globulin
- Need to see cardiologist |
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Term
| Systemic Lupus Erythematosis is an __ disorder most common in __ __ __. In white people it can be identified by a malar butterfly rash. Patients commonly have __, __, __, __, and __ phenomenon. |
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Definition
- autoimmune
- African American Women
- fever
- fatigue
- arthralgias
- alopecia
- Raynaud's phenomenon |
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Term
| Screening tests for Lupus (3): |
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Definition
- ANA (anti-nuclear antibody test)
- CBC with platelets
- urinalysis to test for proteinuria |
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Term
| If Lupus is thought to be drug induced what test should be performed? |
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Definition
| - anti-histone antibody test |
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Term
| Lupus confirmation tests (3): |
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Definition
- Anti-double stranded DNA antibodies
- Anti- Sm (Smith) antibodies
- Biopsy with immunofluorescnence (lupus band test) |
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Term
| Treatment of skin disease associated with Lupus: |
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Definition
- Topical steroids
- Hydroxychloroquine 200 mg qd-bid
- Daily sunscreens
(patients with renal disease have poorer prognosis) |
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Term
| Dermatomyositis is a ___ __ disease. Patients experience __ __ muscle weakness and __ __ on knuckles and __ joints. They also have photosensitivity in sun exposed areas. May also note a __ rash around the eyes and periungal ___.This is like an arthritis with skin involvement. |
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Definition
- collagen vascular disease
- proximal extremity muscle weakness
- Gottron's papules on knuckles
- heliotrope rash around the eyes
- periungal telangiectasia |
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Term
| Patient comes in and tells you they have trouble going from sitting to standing. You have them hold there arms in the air and tell them to resist you, and they can't. You notice papules on knuckles and a racoon eye like rash around their eyes. They have periungal telangiectasia. You diagnose them ___, a __ __ disease. |
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Definition
- Dermatomyositis
- collage vascular disease |
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Term
| Scleroderma is a __ __ disease where the skin tightens up. There is also internal organ involvement. This is very debilitating. You may note ___ hands with fingertip __. They may also have peu de orange. |
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Definition
- connective tissue
- clawed hands with fingertip ulcerations |
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Term
| Cellulitis is a ___ erythema from __ infection of the __ and __ __. It is caused by __ __ and __ __ __. There will be erythema and __ and __. It is common on the __ _. Patients have a __ and feel __. |
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Definition
- localized
- deep infection of the dermis and subcutaneous fat
- staph aureus
- group A strep
- tenderness and warmth
- lower legs
- fever
- ill |
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Term
| Two situations that can lead to cellulitis in elderly? |
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Definition
- dry skin> cracked> junk gets in (tell old people to use lotion)
- edema |
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Term
| In a hospitalized patient with cellulitis __ and __ __ need to be obtained. Treatment usually requires __ __. If it is caught very early on __ __, __, or __ can be used. |
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Definition
- skin and blood cultures
- IV antibiotics
- oral cephalexin, minocycline, or doxycycline |
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Term
| Differential Dx of Cellulitis: |
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Definition
- contact dermatitis
- superficial thrombophlebitis
- deep fungal infection |
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Term
| Abscesses and Furnucles are usually caused by __ __ and are due to __ __. __ need be obtained to rule __. |
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Definition
- staph aureus
- nasal colonization
- Cultures need to be obtained to rule out MRSA |
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Term
| Abscess/Furncle differential Dx: |
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Definition
- cystic acne
- hidradenitis suppurativa |
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Term
| Never ever use ___ for a MRSA infection. |
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Definition
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Term
| If its just a single abscess just do incision and drainage. No antibiotics needed. |
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Definition
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Term
| Furuncle is a __ __. There are usually __ of these, so prescribe __. |
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Definition
- deep folliculitis
- multiple
- antibiotics |
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Term
| If you see a papule or nodule with a vialesce appearane and a trail of skin scale around the edge, it is __ until proven otherwise. Culture it. All weeping oozing things need to be cultured. |
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Definition
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Term
| Abscess and Furuncle tmt: |
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Definition
Treatment includes incision and drainage
Oral antibiotics should be used, especially for patients with multiple lesions
Twice daily nasal application of mupirocin ointment for two weeks may be beneficial
For MRSA infections, treat with oral doxycycline or minocycline |
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Term
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Definition
- Doxycycline
- Minocycline |
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Term
| Erythema __ is a hypersensitivity reaction in the __ __ tissue to an __, __ or __ __. You will see tender, deep erythematous __ or __ usually on the __ __. |
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Definition
- Erythema Nodosum
- subcutaneous fat
- infection, drug, or inflammatory disease
- nodules or papules
- lower legs |
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Term
| quinolones are only used for __. |
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Definition
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Term
| 2 common causes of erythema nodosum: |
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Definition
- oral contraceptive pills
- strep throat infection |
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Term
| Erythema Nodosum lab tests: |
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Definition
- Throat culture
- Antistreptolysin-O titer
- chest X-ray
- TB skin test |
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Term
| Erythema Nodosum treatment: |
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Definition
1. Identify underlying cause
2. NSAIDs
3. Bedrest
4. Support stockings for recurrent disease
5. Prednisone only if severe and not responsive to NSAIDs
(ironic: a few NSAIDs actually can cause this) |
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Term
| A Fixed Drug Eruption will be a __ demarcated red ___ initially, later becoming __. Lesions appear __ to __ __ after first exposure to drug. Commonly seen on __ ___, __, __, and __. |
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Definition
- sharply demarcated
- red plaque
- hyperpigmented
- 1 to 2 weeks after
- distal extremities
- face
- lips
- genitalia |
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Term
| Most common drugs to cause fixed drug eruptions inlcude __,__, __, and __. A __ will confirm diagnosis. |
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Definition
- NSAIDs (ibuprofen)
- Sulfonamides
- Tetracyclines
- Carbamazepeine
- biopsy
(Upon subsequent re-exposure, lesions appear within 24 hours at the same site.) |
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