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236 Cards in this Set

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What are mongolian spots?
blue macules
Fitzpatrick pxxvii
What is alopecia areata?
spot baldness
How should lesions be described?
distribution, configuration, color, secondary changes, primary changes

for example → generalized, discrete, red, scaly papules
What is alopecia totalis?
hair loss from entire scalp
What are milia?
tiny keratin-filled epidermal cysts
What is alopecia universalis?
hair loss from entire body
MILIA:
ETIOLOGY:
dead skin trapped in pockets at surface of skin or mouth

CLINICAL PRESENTATION:
tiny white bumps (1-2 mm keratin-filled epidermal cysts)
found on face, typically nose, cheeks, and chin (in 40% of newborns)
found in mouth and called Epstein pearls, typically roof and gums (in 60-85% of newborns)

MANAGEMENT:
self-limiting → resolves within first few weeks of life
What are examples of macules?
freckles
white macules in vitiligo
port-wine stains
mongolian spots
cafe-au-lait spots
erythema
Fitzpatrick pxxvii
Lichenification is found in what conditions?
atopic dermatitis
ezcematous dermatitis
psoriasis
lichen simplex chronicus
mycosis fungiodes
Fitzpatrick pxxviii
What is acne neonatorium?
neonatal acne vulgaris characterized by inflammatory papules and pustules + occasional comedones on face
Name 9 dermatological disorders due to fungal infection.
tinea capitis
tinea barbae
tinea corporis
tinea manuum
tinea cruris
tinea pedis
tinea unguium/onychomycosis
tinea versicolor
candidiasis
ACNE NEONATORIUM:
ETIOLOGY:
cause unknown
may be associated with increased sensitivity of fetal sebaceous glands to maternal hormones during pregnancy

CLINICAL PRESENTATION:
may present at birth but usually develops between 2-4 weeks
inflammatory papules and pustules
occasionally comedones
usually occur on face (in 20% of newborns)

MANAGEMENT:
self-limiting → resolves within 6-12 months without scarring
What is urticaria?
rash consisting of wheals
Fitzpatrick xxviii
List the conditions characterized by dome-shaped vesicles.
contact dermatitis
dermatitis herpetiformis
Fitzpatrick xxix
What is the common name for miliaria?
heat rash
List the conditions characterized by umbilicated vesicles.
herpes simplex
Fitzpatrick xxix
MILIARIA:
ETIOLOGY:
heat and high humidity → pore closure of eccrine sweat ducts → obstruction of eccrine sweat ducts
superficial obstruction in stratum corneum causes miliaria crystallina
deep obstruction in epidermis causes miliaria rubra

CLINICAL PRESENTATION:
miliaria crystalline → grouped, 1-2 mm, superficial clear vesicles
miliaria rubra → grouped, deep erythematous papules; may progress to pustules; pruritic
both found in intertriginous areas and adjacent skin (neck, upper chest)

MANAGEMENT:
cool environment to prevent sweating
List the conditions characterized by flaccid vesicles.
pemphigus
Fitzpatrick xxix
List transient newborn skin disorders.
milia
acne neonatorum
miliaria
List disorders of sebaceous and apocrine glands.
acne vulgaris
acne conglobata
rosacea
perioral dermatitis
hidradenitis suppurativa
ERYTHEMA TOXICUM:
ETIOLOGY:
cause unknown
associated with eosinophilia
more common if full-term

CLINICAL PRESENTATION:
usually manifests at 24-48 hours but occasionally present at birth
2-3 cm blotchy erythematous macules
may progress to wheals in center of macules
may progress to pustules
range from few to 100
usually occur on chest but also face, back, and extremities

MANAGEMENT:
self-limiting → resolve within 5-7 days
What is the epidemiology for rosacea?
30-50y/o
females > males
10% of fair-skinned
Fitzpatrick p9
erythema toxicum
What are the symptoms/signs that characterize early rosacea?
flushing
telangiectases
papules/pustules

Fitzpatrick p.9
MONGOLIAN SPOTS:
ETIOLOGY:
spindle-shaped pigment cells deep in dermis
occur in Native American, African American, or Asian descent
normal variant

CLINICAL PRESENTATION:
blue-black macule
found in lumbosacral area (and sometimes shoulder, back, or buttocks)

MANAGEMENT:
none → normal variant, may fade with time
Where does rosacea occur?
face in symmetric pattern
rarely scalp, neck, chest, and back

Fitzpatrick p.9
mongolian spot
What are the symptoms/signs that characterize late rosacea?
red facies
dense telangiectases
dusky red papules, pustules, nodules

Fitzpatrick p.9
CAFE AU LAIT MACULES:
ETIOLOGY:
increase in melanin content
normal variant
also consider neurofibromatosis type 1 (if ≥6 lesions >1.5 cm), McCune-Albright syndrome (if large and unilateral), tuberous sclerosis, Fanconi anemia

CLINICAL PRESENTATION:
light brown oval macule on light skin
dark brown oval macule on dark skin
found anywhere on body

MANAGEMENT:
typically none → normal variant, persist throughout life
consider NF-1 if multiple present or increase in number
What are the complications of rosacea?
sebaceous hyperplasia and fibrosis
causing disfigurement of the forehead (metophyma), eyelids (blepharophyma), ears (otophyma), nose (rhinophyma), or chin (gnathophyma)

Fitzpatrick p.9
cafe au lait macules
What is rhinophyma?
sebaceous hyperplasia and fibrosis of the nose
complication of rosacea
cafe-au-lait spot
Name the types of primary lesions.
macule/patch, papule/plaque, wheal, nodule, vesicle/bulla, pustule
PORT WINE STAINS:
ETIOLOGY:
vascular birthmark d/t permanent vascular abnormalities (dilation)
consider Sturge-Weber syndrome (if bilateral facial lesion or covering entire half of face) or Klippel-Trenaunay syndrome (if over extremity)

CLINICAL PRESENTATION:
dark red macules
found anywhere on body

MANAGEMENT:
laser treatment with pulsed dye laser
Name the types of secondary lesions.
scale, crust, erosion, fissure, ulceration, excoriation, lichenification
port-wine stain
What is koebner pnenomenon?
skin lesion at site of trauma
What are port-wine stains?
dark red macules d/t permanent vascular abnormalies
What is auspitz sign?
removal of psoriatic scales that results in pinpoint bleeding
HEMANGIOMAS:
ETIOLOGY:
benign tumor of capillary endothelial cells

CLINICAL PRESENTATION:
permanent blanched area of skin at birth evolves into hemangioma at 2-4 weeks
red rubbery nodule
superficial, deep or mixed

MANAGEMENT:
50% reach maximal regression by 5y/o, 70% by 7y/o and 90% by 9y/o
redundant skin, hypopigmentation and telangiectasia remain
laser therapy with pulsed dye laser may be helpful if ulcerated or bleeding
complications requiring immediate treatment with prednisone:
1. visual obstruction
2. airway obstruction
3. cardiac decompensation
What is nikolsky's sign?
slight rubbing of skin that results in sloughing of outermost layer of skin
hemangioma
Nikolsky's sign may be positive in what conditions?
pemphigus vulgaris
bulbous pemphigoid
toxic epidermal necrolysis
tinea capitis
tinea corporis
TINEA CAPITIS:
ETIOLOGY:
fungal infection of hair and/or scalp caused by Trichophyton tonsurans (90%) or Microsporum canis (10%)

CLINICAL PRESENTATION:
thickened, broken-off hairs 2-3 mm from follicle leaving “black dot” appearance
erythema and scaling of underlying scalp
+/- diffuse pustules on scalp
+/- boggy fluctuant mass (kerion) on scalp suggesting exaggerated host response

MANAGEMENT:
1. wood lamp → Trichophyton tonsurans doesn’t fluoresce, Microsporum canis fluoresces yellow-green
2. KOH
3. fungal culture
4. oral griseofulvin (take with fatty meal to increase absorption)
5. continue fungal cultures every 4 weeks
6. continue medication 4 weeks following negative fungal culture
What is the treatment for tinea unguium/onychomycosis?
1. prescribe terbinafine 250mg tablets PO 1x per day for 6 weeks (fingernails) or 12 weeks (toenails)
2. order HFP mid-way through treatment to screen for hepatotoxicity
Fitzpatrick p1020
TINEA CORPORIS, CRURIS, PEDIS & UNGUIUM
ETIOLOGY:
fungal infection usually caused by Trichophyton mentagrophytes, Trichophyton rubrum, Microsporum canis, Epidermophyton floccosum

CLINICAL PRESENTATION:
tinea corporis → annular marginated plaques with a thin scale and clear center or annular confluent dermatitis
tinea cruris → symmetrical, sharply marginated lesions in inquinal areas
tinea pedis → red scaly lesions on soles of feet or fissuring between toes
tinea unguium (onychomycosis) → yellowed, thickened, crumbling nails

MANAGEMENT:
1. KOH → scrape thin scales from border of lesion, positive for hyphae
2. fungal culture
3. treat tinea corporis, tinea cruris, and tinea pedis with topical → imidazoles, allylamines, benzylamines, or ciclopirox applied twice daily x 3-4 weeks
4. treat tinea unguium with griseofulvin (if refractory, try itraconazole or terbinafine)
What is the most common cause of acanthosis nigricans?
insulin resistance
tinea pedis
cherry angioma
tinea cruris
systemic lupus erythematosus
tinea corporis
xanthomas
tinea unguium
lyme disease
keloid scar
contact dermatitis
acanthosis nigricans
facial telangiectasias → rosacea
angiofibromas
lichen simplex
pitted keratolysis
telogen effluvium
rosacea
eczema herpeticum
hidradenitis suppurativa
alopecia areata
alopecia totalis
wheal
rhinophyma → rosacea
piebaldism
ichthyosis
ichthyosis
bullous pemphigoid
acanthosis nigricans
livedo reticularis
List 1° dermatological lesions.
macule, patch, papule, plaque, vesicle, pustule, bulla, nodule, wheal
List 2° dermatological lesions.
erosion, ulceration, fissure, scale, crust, scar, keloid, atrophy
List special dermatological lesions.
excoriation, comedone, milia, lichenification, burrow, cyst, telangiectasia, petechiae, purpura
What is the ddx for hirsutism?
1. idiopathic → hereditary predisposition
2. physiologic → 3rd trimester pregnancy, menopause
3. endocrine disorder → adrenal enzyme deficiency, polycystic ovarian syndrome, cushing's syndrome
4. neoplasm → adrenal (adenoma, adenocarcinoma, ectopic ACTH-secreting tumor), ovarian
5. medications
Fitzpatrick p990
What are the 3 stages of hair growth?
anagen → growth phase
catogen → degenerative phase
telogen → resting phase
*What is anagen and its duration?
growth phase of hair growth; 1-6 years depending on site of hair follicle
*What is catogen and its duration?
degenerative phase of hair growth where growth stops; lasts 1-2 weeks
*What is telogen and its duration?
resting phase of hair growth where hair sheds; lasts 5-6 weeks
Define hirsutism.
excessive hair growth (abnormal location) in women in androgen-dependent areas
Define hypertrichosis.
excessive hair growth (density, length) in non-androgen-dependent areas
What systemic disorder is associated with acnathosis nigricans?
diabetes mellitus
List 5 pigmentation disorders.
albinism
piebaldism
vitiligo
melasma
post-inflammatory hypo- or hyperpigmetation
What is the etiology of albinism?
genetic disorder (usually autosomal recessive); characterized by normal number of melanocytes but defective synthesis of melanin
Fitzpatrick p341
What is the clinical presentation of albinism?
Hair → varies depending on type; white to light brown, red, platinum
Skin → varies depending on type; white to light tan
Eyes → iris translucency, decreased retinal pigment, nystagmus, strabismus, photophobia, reduced visual acuity, foveal hypoplasia
Fitzpatrick p341
What is the management of albinism?
sun avoidance, protective clothing, daily sunblock SPF >30 to prevent skin cancer; regular visits to dermatologist and ophthamologist; support group
Fitzpatrick p341
What are the complications of albinism?
dermatoheliosis
skin cancer → squamous cell carcinoma, basal cell carcinoma, melanoma
Fitzpatrick p341
What is dermatoheliosis?
photo-aging
What is melasma?
acquired brown hyperpigmentation in sun-exposed areas
Fitzpatrick p344
What is the etiology of melasma?
caused by sunlight exposure; idiopathic or associated with pregnancy, oral contraceptives, estrogen + progesterone replacement therapy, phenytoin
Fitzpatrick p344
What is the clinical presentation of melasma?
hyperpigmented brown macules; sharp borders; located in sun-exposed areas, usually face
Fitzpatrick p344
What class of drug is phenytoin (dilantin)?
anti-epileptic
What is the management of melasma?
1. may resolve spontaneously months after delivery or cessation of hormones
2. topical → hydroquinone or azelaic acid
Fitzpatrick p345
What is the patient education for melasma?
melasma may or may not return with subsequent pregnancies
Fitzpatrick p346
What is the prevention of melasma?
daily use of opaque sunblock containing titanium dioxide and/or zinc oxide
Fitzpatrick p346
melasma
albinism
What is vitiligo?
acquired depigmentation
Fitzpatrick p335
What is the etiology of vitiligo?
absence of melanocytes; associated with autoimmune disease, endocrine disease, trauma, infection, stress
Fitzpatrick p335
What is the clinical presentation of vitiligo?
white macules; sharp borders; symmetric; gradual enlargement of macules or development of new ones; usually generalized
Fitzpatrick p335
What is the diagnostic work-up of vitiligo?
TSH, T4 → thyroid disease associated with 30% of cases
GLUF → DM associated with 5% of cases
Fitzpatrick p336
What is the management of vitiligo?
1. suncreen SPF >30
2. cosmetic coverup
3. if local → repigmentation via topical glucocorticoids or psoralens + UVA
4. if widespread → repigmentation via oral psoralens + UVA
4. if extensive or failed repigmentation → depigmentation by bleaching
Fitzpatrick p340
hirsutism
vitiligo
vitiligo
List 5 conditions characterized by scaling lesions.
psoriasis
seborrheic dermatitis
pityriasis rosea
lichen planus
icthyosis
What systemic disorder is associated with xanthomas?
hyperlipidemia
What systemic disorder is associated with blue-grey macules on the lips?
Peutz-Jeghers syndrome
Define petechiae.
small (<0.3cm) red or purple skin discoloration; non-blanching; indicative of broken capillary
Define purpura.
medium (0.3-1cm) red or purple skin discoloration; non-blanching
Define ecchymosis AKA hematoma AKA bruise.
large (>1cm) red or purple skin discoloration; non-blanching
What does non-blanchable indicate?
blood located outside vessel walls
nail pitting
psoriasis
alopecia areata (transverse bands)
splinter hemorrhages
if distal: minor trauma, atopic dermatitis, psoriasis
if proximal: sideropenic anemia, bacterial endocarditis, trichinosis, antiphospholipid antibody syndrome, altitude sickness
Upon palpation of a lesion, what are you assessing?
temperature (hot, cold)
depth (dermal, subcutaneous)
consistency (soft, firm, hard, fluctuant)
mobility
tenderness

Fitzpatrick xxxiii
Upon inspection of a lesion, what are you assessing?
type
size
shape (linear, round, oval, annular, target, serpiginous)
color
margination (well-defined, ill-defined)
number (single, multiple)
arrangement (discrete, grouped, confluent)
extent of distribution (localized, generalized)
pattern of distribution (random, symmetric, sun exposed areas, pressure points, dermatomal)
Describe a positive auspitz sign.
when slight scraping of a scaly lesion reveals bleeding points in lesion
suggestive of psoriasis but non-specific

Fitzpatrick xxxv
Describe a positive Nikolsky sign.
when lateral shearing pressure from a finger causes epidermis to dislodge from dermis resulting in an erosion
suggestive of pemphigus, staphylococcal scaled skin syndrome, or toxic epidermal necrolysis

Fitzpatrick xxxvi
Describe a positive Darier sign.
when a macule/papule becomes a palpable wheal after being vigorously rubbed w/ an instrument such as the blunt end of a pen
wheal may not appear for 5-10min.

Fitzpatrick xxxv
In dermatology, should the history be taken before or after the physical exam?
after
b/c patient's can see skin lesions and thus the history may be flawed w/ their own interpretation of the cause
b/c clinician more objective w/out preconceived ideas

Fitzpatrick p. xxvi
What is a macule?
circumscribed flat lesion
any size
any color
non-palpable
well or ill-defined

Fitzpatrick p. xxvii
What is diascopy?
examination of red skin lesions by pressing glass slide to lesion to determine if blanching (erythema) or non-blanching (purpura) lesion

Steman's & Fitzpatrick p. xxvii, xxxv
In diascopy, what do blanching lesions indicate?
if redness disappears, lesion is due to vascular dilation

Fitzpatrick p. xxvii
In diascopy, what do non-blanching lesions indicate?
if redness remains, lesion is due to extravasated RBCs (i.e. purpuric)

Fitzpatrick p. xxvii
What are 13 criteria for describing inspection and palpation of skin lesions?
type
size
shape
color
margination

number
arrangement
distribution

temperature
depth
consistency
mobility
tenderness

Fitzpatrick p. xxvii, xxxiii
What is a papule?
superficial elevated solid lesion <0.5cm in diameter
flat-topped, dome-shaped, cone-shaped, or vegetation (multiple, small, closely packed)
palpable
well (superifical) or ill-defined (deeper dermal)

Fitzpatrick p. xxvii
What is a plaque?
superficial elevated solid lesion >0.5cm in diameter
plateau-like (large surface area in comparison to height)
often well-defined
often formed by confluence of papules

Fitzpatrick xxviii
What is lichenification?
ill-defined plaque
thickened skin
accentuated skin markings

Fitzpatrick xxviii
What is a patch?
lesion b/w macule and plaque
barely elevated plaque

Fitzpatrick xxviii
What is a nodule?
palpable, solid, round or ellipsoidal lesion that is larger/deeper than a papule
may involve epidermis, dermis, or subcutaneous tissue
dome-shaped and smooth, crater-like central depression, or warty
soft or hard
well (superificial) or ill-defined (deep)

Fitzpatrick xxviii
What is a wheal?
elevated papule or plaque
flat or round-topped
round, gyrate, or irregular w/ pseudopods (slender extensions from wheal)
pale red
changes rapidly in size and shape due to shifting edema in papillary body of dermis
disappears w/in 24 hours

Fitzpatrick xxviii
What is a vesicle?
superficial circumscribed elevated fluid-filled cavity <0.5cm in diameter
dome-shaped, umbilicated, or flaccid
subcorneal, epidermal, or epidermal-dermal
often transparent roof
yellowish (if serum-filled) or red/black (if blood-filled)
well-defined

Fitzpatrick xxix
Are well-defined lesions superficial or deep?
superficial

Fitzpatrick xxix
Are ill-defined lesions superficial or deep?
deep

Fitzpatrick xxix
What is a bulla?
superficial circumscribed elevated fluid-filled cavity
>0.5cm in diameter
dome-shaped, umbilicated, or flaccid
subcorneal, epidermal, or epidermal-dermal
often transparent roof
yellowish (if serum-filled) or red/black (if blood-filled)
well-defined

Fitzpatrick xxix
How would you describe the color of a lesion?
white, yellow, pink, red, purple, blue, tan, brown, grey, black
uniform or variegated

Fitzpatrick xxxiii
How would you describe the margination of a lesion?
well-defined (can be traced w/ pencil) or ill-defined

Fitzpatrick xxxiii
How would you describe the shape of a lesion?
linear
round
oval
annular (ring-shaped)
reticular (net-like)
serpiginous (snake-like)
umbilicated
target/iris

Fitzpatrick xxxiii
What are Blaschko lines?
a distribution pattern of skin lesions or pigmentary anomolies
linear on extremities, S-shaped on abdomen, V-shaped on back
though to result from genetic mosaicism

Stedman's
How would you describe the arrangement and distribution of lesions?
number: single or multiple
arrangement: discrete, grouped, or confluent
distribution extent: isolated, localized, regional, generalized, universal
distribution pattern: random, symmetric, exposed areas, pressure sites, follicular, dermatomal, following Blaschko lines

Fitzpatrick xxxiii
When using a wood lamp, what does coral red fluorescence indicate?
erythrasma

Fitzpatrick xxxv
When using a wood lamp, what does pinkish-red fluorescent urine indicate?
porphyria

Fitzpatrick xxxv
When using a wood lamp, what does yellow-green fluorescence indicate?
dermatophytosis

Fitzpatrick xxxv
clubbing
koilonychia (AKA spooning)
pitting
Beau's lines
onycholysis
Terry's nails (AKA white nails)
yellow nails
splinter hemorrhages
half-and-half nails
Muehrcke's lines
onychomycosis
What is the pathophysiology of clubbing?
connective tissue enlargement resulting from chronic oxygen deficiency
What is the ddx for clubbing?
atrioventricular malformations
congenital heart disease
endocarditis
asbestosis
chronic bronchitis
COPD
pulmonary malignancy
cirrhosis
inflammatory bowel disease
celiac disease
fistulas
What sign tests for clubbing?
Schamroth sign
How do you perform Schamroth sign?
oppose distal phalanges
positive if normal diamond-shaped space b/w phalanges is missing
What is the ddx for koilonychia (AKA spooning)?
trauma
iron deficiency anemia
hemochromatosis
SLE
Raynaud's disease
nail-patella syndrome
What is the ddx for pitting?
alopecia areata
psoriasis
incontinentia pigmenti
reactive arthritis
What is the ddx for Beau's lines?
trauma
severe illness
pemphigus
Raynaud's disease + cold exposure
What is onycholysis?
detachment of nail from nail bed resulting in white discoloration in affected area
What is the ddx for onycholysis?
trauma
infection
psoriasis
hyperthyroidism
amyloidosis
sarcoidosis
connective tissue disorders
What is the ddx of Terry's nails (AKA white nails)
malnutrition
CHF
cirrhosis
hepatic failure
DM
hyperthyroidism
What is the ddx for splinter hemorrhages?
trauma
psoriasis
bacterial endocarditis (associated w/ fever & heart murmur??)
peptic ulcer disease
RA
SLE
antiphospholipid syndrome
malignancies
pregnancy
oral contraceptive use
What is the ddx of half-and-half nails?
renal failure
What is the ddx for Muehrcke's lines?
hypoalbuminemia 2° to:
malnutrition
hepatic disease (liver synthesizes albumin)
What are the ABCs of potentially cancerous lesions?
A → assymetry
B → irregular borders
C → color changes
D → diameter >6mm
E → elevation
During a skin exam, what are you assessing?
color
moisture
temperature
texture
mobility
turgor
lesions
List 12 infectious diseases that cause a rash.
1. varciella (chickenpox)
2. herpes zoster (shingles)
3. rubeola (measles)
4. rubella (german measles)
What is the common name for varicella?
chickenpox
What is etiology of varicella?
varicella zoster virus (VZV) AKA HHV-3
spread via respiratory droplets or lesion contact
peak age 5-10
year round
highly contagious
Current p1239
What is the clinical presentation of varicella?
10-21 day incubation period
1-3 day prodrome with variable symptoms (mild fatigue, fever, HA, respiratory sxs)
red maculopapules → clear vesicles on erythematous base ("dew drop on a rose petal") → pustules (superficial and elliptical with serrated borders) → crusts over 5-6 days
affects scalp, face and trunk → extremities
lesions can also occur in nose, mouth, conjunctiva, vagina
pruritis
Current p1239
What is the time frame for varicella lesions?
new lesions for 1-7 days
crusts slough in 7-10 days
What is the diagnostic work-up for varicella or herpes zoster?
diagnosis usually made clinically; confirmation via DFA or PCR
Current p1241
What are the complications of varicella?
pitted scars
2° bacterial skin infections → staph, group A strep
Current p1241
What is the management of varicella?
1. acetominphen for fever
2. antihistamines or cool soaks for pruritus
3. acyclovir if chronic disease or immunocompromised
3. keep fingernails short and skin clean to prevent 2° bacterial skin infections and scarring
4. bed rest until afebrile
5. isolation until crusts disappear
Current p1242
What is the prevention for varicella?
vaccination via VARIVAX (varicella only) or MMRV at 12-15 months and 4-6 years
Current p1241
When should the MMR and varicella vaccinations be given?
12-15 months and 4-6 years
Current p1241
varicella
What is the common name for herpes zoster?
shingles
What is the etiology of herpes zoster?
varicella zoster virus (VZV) AKA HHV-3; manifests due to prior varicella + declining immunity; usually affects adults >60y/o
Current p1239
What is the clinical presentation of herpes zoster?
severe pain before onset of rash; lesions resembling chickenpox; dermatomal distribution
Current p1241
What dermatomes are most commonly affected in herpes zoster?
thoracic and lumbar roots
Current p1241
What is the most common complication of herpes zoster?
postherpetic neuralgia → 60-70% if >60y/o
Current p1241
What is the management of herpes zoster?
if uncomplicated → acyclovir 800mg PO 5x daily x 7 days within 72 hours of rash onset
Current p1242
What is the prevention for herpes zoster?
VZV vaccine at ≥60y/o
Current p1241
herpes zoster
What is the common name for rubeola?
measles
What is the etiology of rubeola?
caused by a paramixovirus; spread via respiratory droplets; virtually eliminated in U.S.
Current 1247
What is the clinical presentation of rubeola?
10-14 day incubation period for onset of rash; prodrome of fatigue, fever, conjunctivitis, photophobia, rhinorrhea, cough, Koplik spots; maculopapular rash, 3-4 days after onset of prodrome, brick-red, irregular; face → downward and outward including palms and soles
Current 1247
What is the diagnostic work-up of rubeola?
usually diagnosed clinically; supported by IgM measles Ab
leukopenia
Current 1248
What disease are Koplik spots associated with?
rubeola
Current 1248
What are Koplik spots?
prodromic enanthem of rubeola; resemble grains of salt on wet background; found on buccal mucosa
"Grains of salt on a wet background" describe?
Koplik spots
What are the complications of rubeola?
1. diarrhea and protein-losing enteropathy → especially significant in malnourished
2. bronchopneumonia or broncholitis
3. secondary bacterial infections
4. encephalitis
Current p1248
What is the management of rubeola?
Supportive:
1. acetominophen for fever
2. vitamin A 200,000 units/d PO x 2 days
3. antibiotics for 2° bacterial infections
4. fluids as necessary
5. bed rest until afebrile
6. isolation for 1 week following onset of rash
Current p1249
What is the prevention of rubeola, mumps, rubella, and varicella?
MMRV vaccine at 12-15 months and 4-6 years
Current 1249
koplik spots → rubeola
rubeola
rubeola
What is the common name for rubella?
german measles
What is the etiology of rubella?
caused by a togavirus; spread via respiratory droplets; fetal rubella common in third world countries
Current p1254
What is the clinical presentation of rubella?
50% asymptomatic
fatigue, fever, rhinorrhea
suboccipital, postauricular and posterior cervical lymphadenopathy
rash → maculopapular, fine, pink; face → trunk → extremeties; fades quickly lasting 1 day each area
if adult → 25% polyarticular arthritis of wrists, fingers, knees for 1 to several weeks
Current p1254
What is the diagnostic work-up of rubella?
IgM Ab, 4-fold rise in IgG Ab, viral PCR, or viral culture
Current p1254
What is the procedure for serological testing of rubella on pregnant women?
1. rubella ordered to R/O possibility of prenatal infection
2. positive IgG suggests vaccination or past infection
3. positive IgM suggests POSSIBLE current infection but interpret with caution
4. negative IgM and IgG requires clinical observation and serological follow-up
Current p1254
What are the complications of rubella?
congenital rubella → teratogenic → permanent congenital defects, high mortality rate
Current p1254
What is the management of rubella?
Supportive:
1. acetominophen

If prenatal:
1. possible therapeutic abortion
Current p1254
What are the differences between postnastal and congenital rubella?
postnatal → mild, usually lasts 3-4 days

congenital → teratogenic → congenital defects and high mortality rate
rubella
What disease is characterized by rash starting on face and spreading downward and outward to palms and soles?
rubeola
What disease is characterized by rash starting on trunk and spreading to extremities?
varicella
What disease is characterized by rash starting on face, then spreading to trunk, then extremeties in quick sucession, lasting 1 day each?
rubella
What is the etiology of toxic shock syndrome (TSS)?
caused by staph aureus toxin; associated with tampon use, abscess, etc.
Current p1296
What are 3 disorders caused by S. aureus toxins?
1. scalded skin syndrome → affects children
2. toxic shock syndrome → affects adults
3. enterotoxin food poisoning
Current p1296
What is the clinical presentation of TSS?
diffuse "sun burn" rash
desquamation, especially palms and soles, over 1-2 weeks

high fever, hypotension, involvement of 3 or more organ systems
HA, nonpurulent conjunctivitis, sore throat, vomiting, watery diarrhea, myalgia
Current p1296
What is the diagnostic work-up of TSS?
BC → negative since caused by toxin not systemic infection
vaginal or wound culture
Current p1296
What is the management of TSS?
1. rapid rehydration
2. remove tampon, drain abscess, etc.
3. antibiotics
Current p1296
What are the complications of TSS?
heart failure
kidney failure
liver failure
shock

15% mortality rate
Current p1296
What is the prevention of tampon-associated TSS?
avoid use of tampons or use less frequently
change tampons often
What is the etiology of Kawasaki disease?
idiopathic; usually affects children 3 months to 5 years, Asians or Pacific Islanders
Current p1288
What is the clinical presentation of Kawasaki disease?
fever + 4 of the following criteria x 5 days:
1. bilateral nonexudative conjunctivitis
2. mucous membrane changes → swelling and fissuring of lips, erythematous pharnyx, or strawberry tongue
3. peripheral extremity changes → erythema, edema, induration, desquamation
4. polymorphous rash
5. beau lines
6. cervical lymphadenopathy >1.5cm
Current p1288
What is Kawasaki disease?
vasculitis characterized by infiltration of vessel walls with mononuclear cells and later by IgA secreting plasma cells → destruction and aneurysm formation
Current p1288
What are the complications of Kawasaki disease?
arteritis of the coronary vessels
coronary aneurysm
MI
Current p1288
What is the management of Kawasaki disease?
1. IVIG within first 10 days
2. if fever persists → 2nd dose of IVIG
3. if fever persists → methylprednisolone
4. echocardiogram
5. if coronary aneurysm → low-dose aspirin + warfarin
3. if MI → thrombolytics, CABG, PCCI, cardiac transplant
4. regular follow-up with cardiologist → coronary aneurysms may occur at 30-50y/o
Current p1288
Define arteritis.
inflammation of arterial walls
kawasaki disease
When is varicella no longer contagious?
when crusts begin to form