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60 Cards in this Set
- Front
- Back
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What are the 5 bullous and blistering diseases to know?
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Pemphigus Vulgaris, Bullous Pemphigoid, Pemphigus foliaceus, Porphyria Cutanea Tarda, Drug eruptions/hypersensitivity
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What are you thinking if you see a pt. with a PAINFUL burn like features and a bullae is present that is thin and fragile?
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Pemphigus Vulgaris
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What is the MOA of pemphigus vulgaris?
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antibodies againsst the antigens in the intercellualr spaces of the epidermal cella
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What are you thinking is you see a bulle from destruction within the epidermis?
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Pemphigus Vulgaris
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What are you thinking if you see a pt. who was on captopril with PAINFUL burn like features where the bullae that is thin and fragile?
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Pemphigus Vulgaris
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Waht are you thinking if you see a pt. on Penicillamine who has a bullae that was developed from within the epidermis?
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Pemphigus Vulgaris
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What will you do to diagnose Pemphigus Vulgaris?
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Nikolsky's sign
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What do you see when you do Nikolsky's sign?
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easy removal of the skin by Just a little pressure
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What diseases have a positive Nikolsky's sign
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Pemphigus vulgaris, Staph Scalded Skin, and TEN
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Are the lesions in Pemphigus Vulgaris painful or Puritic?
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PAINFUL
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What is the most accurate diagnostic test of Pemphigus Vulgaris?
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Biopsy of the skin
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What is the treatment of Phemphigus Vulgaris?
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Steroid--prednisone
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What if you see a pt. with a PAINFUL bullae the has a positvie Nikolsky sign...what are you thinking? You also started steroids, but it doesn't work, what should you do now?
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Pemphigus Vulgaris
TXt: give Azathiaprine Mycophnolate Cyclophosphamide |
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How does bullous phemphigoid and pemphigus vulgaris differe?
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Bullae of phemphigoid is much thicker and less likely to rupture
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Which one is more likely cause by sulfa drugs bullous pemphigoid or pemphigus vulgaris?
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bullous phemphigoid
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Will you see oral lesions in bullous pemphigoid?
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NO
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Which one is more likely to get an infection bulloous pemphigoid or phemigus vulgaris?
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Pemphigus vulgaris
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Which one has a greater risk of mortality bulloous pemphigoid or phemigus vulgaris?
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pemphigus vulgaris---b/c more likely to get infx.
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What would you do to diagnose bulloous pemphigoid ?
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Biopsy with immunoflurorescent Antibodies
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What do you treat bullous pemphigoid with?
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Steroids---prednisone
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What if you treated bullous pemphigoid with steroids but pt. doesn't tolerate it well, what else can you use?
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Tetracyclin OR
Erythromycin with nictinamide |
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What age range will you see bullous pemphigoid?
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70-80
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What age range will you see pemphus vulgaris?
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30-40
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Which is more severe bullous pemphigoid or pemphus vulgaris ?
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pemphigus
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Which has mouth involvement bullous pemphigoid or pemphus vulgaris ?
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pemphigus Vulgaris
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Which had a thich and intact bullae bullous pemphigoid or pemphus vulgaris ?
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bullous pemphigoid
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Which is thin and FRAGILE bullous pemphigoid or pemphus vulgaris ??
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pemphigus vulgaris
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How do you MOST ACCurate diagnose pemphigus vulgaris?
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biopsy of the skin
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How does pemphigus foliaccus differ from pemphigus vulgaris?
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More superficial than Pemphigus vulgars, the bullae is INTACT, and NO ORAL lesions
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Can pemphigus foliaceus be induced from ACE-I and NSAIDS?
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YES
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How is Pemphigus Foliaceus diagnosed?
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By skin biopsy
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How is Pemphigus Foliaceus treated?
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Steroids
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what do you suspect if there is a pt. with some liver abnormality and has a non-healing blister on a SUN-exposed body part (back of hand or face), hyperpigmented skin, or hypertrichosis of the face?
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Suspect Porphyria Cutanea Tarda
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What do you see in a pt. with an abnormal porphyrin metabolism with abn. high accum of porphyrins?
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Think Porphyria Cutanea tarda
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What diagnostic test to you do for Porphyria Cutanea Tarda
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Test for urinary uroporhyrins
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What will the diagnostic test show if porphyria Cutanea tarda is suspected?
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Uroporphyrins elevated 2-5 X more than copoporphyrins
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What do you do if you suspect Porphyria Cutane Tarda?
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Stop drinking ETOH
Stop estrogen Use sunscreen Do phlebotomy to remove iron or Deferoxamine Chloroquine increases excretion of porphyrins |
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What if you see a pt. with evanescent wheals and hives, what is this due to?
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IgE and mast cell activation
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What type of reaction is acute uticaria?
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Hypersensitivity reaction
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Do you get hemodynamic instability or hypotension in uticaria?
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NO
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How long does uticaria last?
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30min to 1 day
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What will you see more in uticaria ITCHING or PAIN?
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Itching
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What are the most common causes of uticaria?
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MICE Food
M-eds--aspirin, NSAID, morp, I-nsect bite Contact E-motions F-ood---peant, shellfish, strawb |
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What is dermatographism?
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Pressure on the skin resulting in a localized uticaria
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What else can chronic uticaria develop from other thanpressure on the skin?
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Cold, Vibration
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How do you treat uticaria?
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H1 antihistamine---
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What do you treat severe acute uticaria with ?
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Benedryl, Hydroxyzine, cyrpoheptadine
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What do you do if uticaria is life threatening reaction?
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Give Systemic steroids
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What do you treat chronic, not life threatening uticaria with?
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Fexofenidine, Loratadine, desloratadine, cetirizine
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What do you do if the trigger can not be avoided and pt. continually gets uticaria?
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Desensitize
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A pt. is on metoprolol and is a farm worker that constantly gets stung by bees, and develops uticaria...what should you do?
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sTop b-blocker and DESENSITIZE the pt.,
b-blocker with counter the effect of epi if needed to treat the an anaphylactic reaction |
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What type of rash will you see that is milder than uticaria and is typical type of drug reaction?
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Morbilliform Rash
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What does a morbillform rash look like?
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Looks like measles---generalized macpap eruption that blanches with pressure
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Can a morbilliform rash develop after a medication has been stopped?
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YES
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Morbilliform rash is a lymphocyte mediated rash, what do you use to treat it?
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Anti-histamine
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Do you have to use steriods in morbilliform rashes?
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Rarely
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When you see PCN, Phyentoin, NSAID, sulfa drugs, ro Infx. with HSV or Mycoplasma with targetlike lesions ON PALMS and SOLES, what are you thinking?
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Erythema Multiforme
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What is the description used to describe EMultiforme lesions
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Target like or Iris-like
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Does EMultiforme involve teh mucous membranes?
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NO
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Waht do you treat EMultiforme with?
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Anti-histamine and treat teh underlying infection
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