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26 Cards in this Set
- Front
- Back
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Exanthem vs Enanthem
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Exanthem - eruption or skin rash with sudden onset and generalized distribution (most of body)
Enanthem - same but on mucous membranes Exanthems (common) - measles, scarlet fever, erythema infectiosum, roseola, varicella |
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Measles, Cause, Presentation, Clinical findings, Course, Diagnosis, Complications, Treatment
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Rubeola
Cause: paramyxovirus Presentation: Prodrome (3C's) of cough, coryza, conjunctivitis, fever, Clinical findings: Enanthem of Koplik spots (pathoneumonic but only last a day) (white papules on buccal) and Exanthem of red macules and papules 2-4 days after prodrome on head moving downward Course: Prodrome, 2-4 days later enanthem and exanthem, contagious for 4 days post rash Complications: pneumonia, bronchitis, otitis, encephalitis, death Diagnosis: serology (titers) Treatment: supportive, VitA. Vaccine exists given at 1 year and 4-6 year |
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Prodrome of coryza, cough, conjunctivitis & what to look for
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Measles/Rubeola
caused by paramyxovirus Buccal enanthem - Koplik spots Enanthem over whole body |
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Scarlet Fever Cause, Presentation, Clinical findings, Course, Diagnosis, Complications, Treatment
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Cause: Group A Strep (S. pyogenes)
Presentation: fever, sore throat, headache Clinical Findings: Exanthem of fine red macules and papules on trunk and extremities (sandpapery goose flesh), and accentuated in flexures. Enanthem: petechial strawberry tounge Course: 4-5 days, desquamation Complications: rheumatic fever, pneumonia, pericarditis, meningitis, glomerulonephritis Diagnosis: throat swab (rapid antigen, culture) Treat: penicillin family, erythromycin if allergic. MUST Treat within 9 days of symptoms to prevent ARF development |
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Prodrome of fever, sore throat, headache & what to look for
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Group A strep/scarlet fever
Strawberry toungue pathoneumonic Exanthem on TRUNK and Extremities |
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Treatment considerations for Scarlet Fever
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Must treat within 9 days to avoid development of acute rheumatic fever due to group A strep
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Erythema Infectiosum Cause, Presentation, Clinical findings, Course, Diagnosis, Complications, Treatment
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Cause: Parvovirus B19
Presentation: Prodrome of fever, chills, headache. Clinical Findings: 3 stage rash Stage 1 - fiery red patch on cheeks Stage 2 - lacy red patches arms and legs Stage 3 - intermittent waxing and waning of rash (worse with sun exposure) Course: Mild, NOT contagious when rash appears Complications - arhtritis, aplastic anemia (in sickle cell pts or spherocytosis), fetal hydrops in pregnant women Dx: titers Treat: supportative |
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Meales vs Erythema Infectiosum Contagiousness when rash present
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Measles - yes
EI - no |
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Roseola Infantum Cause, Presentation, Clinical Findings, Course, Complications
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Cause: HHV6, HHV7
Presentation: <3 y/o, high fever 3-5 days then rash Clinical Findings: Exantham of red macules and papules on trunk spreading out Course: Resolves 1-3 days Complications: febrile seizures, periorbital edema |
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Which disease has a complication of febrile seizures
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Roseola Infantum
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Varicella Cause, Presentation, Clinical findings, Course, Diagnosis, Complications, Treatment
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Cause: varicella zoster virus (VZV)
Presentation: Red papule to vesicle to crust AT ALL STAGES on pt. "dew drops on a rose petal" starting on trunk and spreading outward Course: highly contagious respiratory OR contact. Diagnosis: Viral culture, PCR, Tzanck prep (multinucleated giant cells) Complications: secondary bacterial infection, pneumonia, encephalitis, hepatitis Treatment: supportative, can use acyclovir in high risk Vaccine exists |
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Varicella Breakthrough disease
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Pts getting vaccine can still get mild case of disease (4-5 lesions)
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Staphylococcal Scalded Skin Syndrome (SSSS) Cause, Presentation, Clinical findings, Course, Diagnosis, Complications, Treatment
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Cause: S. aureus phage group II (exotoxin). Toxin causes separation of granular layer of epidermis
Presentation: Child under 6 OR adults with kidney disease (cant clear toxin). Painful, erythema around mouth and in skin folds Clinical findings: superficial blisters and erosions; Nikolsky sign of pressure on skin = epidermal peel. "sad clown face" Course: mild and localized to widespread sloughing Complications: fluid loss, electrolyte imbalance, temp instability, sepsis, death Diagnosis: isolate organism from oropharynx or conjunctiva Treat: hospitalize, wound care, clindamycin or vancomycin (s. aureus) |
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Isolating SSSS
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usually negative in skin and blood, take sample from oropharynx or conjunctiva
since it is a toxin mediated disease harder to isolate organism |
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Bullous impetigo
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Very localized SSSS lesion
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Hand-foot-and-mouth-disease Cause, Presentation, Clinical findings, Complications
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Cause: Coxsackievirus A16 - enterovirus
Presentation: fever and malaise. Lesions limited to palms, sores, and around mouth Clinical findings: Exanthem of grey-white oval vesicles on palms and soles. Enanthem of vesicles and erosions Complications: dehydration risk |
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Warts Cause, Presentation, Clinical findings, Diagnosis, Course, Treatment
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Cause: Human papillomavirus strains
Presentation: skin contact or fomite contact inoculation leading to pain, bleeding. (10% children get) Diagnosis: culture, Tzanck Course: 2/3 will sponteneously resolve in 2 years Treatment: watch if a child, or saliacylic acid, liquid nitrogen, laser. Immunotherapy with imiqumod cream, cimetidine, squaric acid, Candida Ag injection |
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Molluscum Contagiosum Cause, Presentation, Clinical findings, Diagnosis, Course, Complications, Treatment
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Cause: Poxvirus, common skin to skin spread
Presentation: painful, pruritic, associated dermatitis and bleeding Clinical Finding: primary lesion of pearly umbilicated papule, congregates in skin folds Course: most resolve in 18 months, more severe if pt has atopic dermatitis. Not harmful but can be itchy or painful Treatment: waiting, if symptomatic apply cantharidin (vesicant or blistering agent to pull out viral core and induce inflammation) |
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Excema Herpeticum Cause, Presentation, Clinical findings, Course, Diagnosis, Complications, Treatment
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Cause: Actopic dermatitis patients with an HSV1 infection on top
Presentation: Life threatening vesicles that then crust over spreading rapidly and leaving "punched out erosions" Course: Risk for organ involvement, ocular damage, secondary infection Diagnosis: PCR, culture, Tzanck Complications: organ involvement, ocular damage, 2ndary infection Treat: systemic antivirals, hospital |
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Scabies Cause, Presentation, Clinical findings, Course, Diagnosis, Complications, Treatment
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Cause: Sarcoptes scabiei (a mite affecting only humans), burrows and lives in epidermis. Transmitted by close contact
Presentation: extreme pruritis, worse at night, people living with also have Clinical Findings: Primary lesion of a burrow, then secondary lesion of hypersensitivity to mite (scabietic nodules). Linear track from the burrow. Look on palms, soles, webbed spaces Diagnosis: mineral oil prep of a scrape from a burrow looking for mite Treatment: Permethrin 5% cream (on at night, sleep in and wash in morning), clean house, Precipitated sulfur if a under 2 months or pregnant, Ivermectin can be used TREAT ALL IN CONTACT not just symptomatic. Repeat if symptomatic |
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Head Lice Cause, Presentation, Clinical findings, Diagnosis, Treatment
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Cause: pediculus humanus capitis, obligate human parasite transmited with contact or fomites
Presentation: Very pruritic, live lice on scalp, nits in hair shaft (eggs). Nits more likely means active infection esp. closer to scalp. Diagnosis: nit or live louse Treatment: Permethrin 1% (not lidane b/c neurotoxic. Repeat at 2 weeks for any eggs. |
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Hemangiomas Presentation, Complications, Treatment
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Birthmark that is actually a vascular tumor, most common benign tumor in infants (12% get one).
Presentation: female, preterm or low body weight infant, small flat lesion quickly grows in first 3 months then gone by 5. Complications: rare but PHACES, ulceration, bleeding, airway involvement, VISUAL compromise, liver involvement, HYPOthyroidism Complications esp. with "beard hemangioma" Treatment: mostly wait and resolves, propanolol helps. surgery if really bad |
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Port wine stains (PWS) Presentation, Distributions, Complication, Treatment
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Birthmark due to capillary malformation
Presentation: Pink to red to purple stain anywhere on body but usually on face Distributions: usually follow V1 (forehead and eye), V2 (concentric to V1 but down to upper lip), V3 same but to chin Complications: Sturge-Weber-Syndrome especially with V1 (forehead and eyelid), at risk for ipsilateral cerebral vascular malformations and glaucoma |
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Cafe-au-lait macules Presentation, Complications
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Brown or tan macules or patches birthmark,
Presentation: usually skin-fold freckling of brown macules or patches Complications: >6 is a risk for neurofibromatosis type 1. Freckling in NF1 also more in axilla and groin. neurofibromas usually start at peuberty and can become internal nerve fibromas and multiorgan |
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Ash-leaf macules Presentation, Complications
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Birthmark of hypopigmented macules
Complications: >3 is t risk for angiofibromas (red papules) around mouth, seizurse and developmental delay |
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Associated Complications for birthmarks a)Hemangiomas b)Port Wine Stain c)cafe-au-lait macules d)Ash-leaf macules
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a) PHACES syndrome, ulcers
b) Sturge Weber syndrome (PWS, ipsilateral cerebral vascular malformations, glaucoma) c) Neurofibromatosis Type 1 if 6 or more d) angiofibromas if 3 or more, also seizures and developmental delay |
