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70 Cards in this Set

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  • Back
What is the incubation period for Measles?
8-12 days after initial exposure the Paramyxovirus
Cough + Coryza + Conjunctivitis = ?

**occur 2-3 days of onset of symptoms (of 3 C's)
Small irregular red spots with central gray or bluish white specks...what disease?
Approximately 5 days after the onset of symptoms, an erythematous maculopapular rash erupts on the head & spreads caudally, lasting 4-5 days
What are 2 severe complications of Measles?
Acute Encephalitis

Subacute Sclerosing Panencephalitis
This infection has an incubation period of 14-21 days. When symptoms do occur, an erythematous maculopapular, discrete rash, with generalized lymphadenopathy & slight fever. The rash rarely last longer than 5 days. Fever may accompany the onset of rash.
This is common in adolescents with Rubella infection
Polyarthralgia & Polyarthritis
These 2 things are rare complications of Rubella infection
Encephalitis & Thrombocytopenia
Common acute disease of infants & young children caused by Human Herpesvirus 6 (HHV-6)
Roseola Infantum
Illness that begins with an abrupt fever characterized by temps of 103-106F that persists for 1-5 days. During the fever, the child generally appears well & has no physical findings to explain the fever. On the 3rd-4th day, a maculopapular rash appears on the trunk & spread peripherally. The rash typically appears as the fever resolves. Initially, leukocytosis up to 20,000 microliters with a left shift may exist, but by the 2nd day of illness, leukopenia & neutropenia may be noted.
Roseola Infantum (HHV-6)
What complication may occur in Roseola Infantum?
Febrile Seizures due to rapid increase in temp during onset of infection
Describe the 3 stages of the rash in Erythema Infectiosum (Fifth Disease)
1. marked redness of the cheeks = "slapped cheek"

2. lacy or reticulate, red, pruritic rash then starts on the arms & spreads to trunk & legs

3. Fluctuations in the severity of the rash lasting for 2-3 wks. Fluctuations occur with temp changes & exposure to light
What are 3 complications of Erythema Infectiosum?

Hemolytic Anemia

When is Hand-foot-and-mouth disease common? (what part of the year)
Spring & Summer
What virus causes hand-foot-and-mouth disease?
Coxsackie A virus
Describe the symptoms of hand-foot-and-mouth disease
Prodrome of fever, anorexia, & oral pain

Crops of ulcers on the tongue & oral mucosa & a vesicular rash on the hands, feet, & occasionally buttocks

Individual vesicles often have a "football" shape with surrounding redness
When can fatal disseminated Varicella (chickenpox) develop?
1. in immunocompromised children

2. neonates whose mothers develop the infection within 1 week of delivery
Describe the disease progression of Varicella
-incubation of 10-21 days
-prodrome of mild fever, malaise, anorexia, & occasionally a scarlatiniform or morbilliform rash
-Pruritic rash occurs on following day appearing first on the trunk & then spreading peripherally. Rash begins as red papules & develops rapidly into vesicles. Vesicles then become cloudy, break, & form scabs. Lesions occur in widely scattered "crops", so several stages of lesions are usually present at the same time
When are patients infectious with Varicella?
from 24 hours before the appearance of the rash until all the lesions are crusted, which usually occurs 1 wk after the onset of the rash
What 3 things may occur in immunocompromised patients with Varicella infection?
1. Meningoencephalitis

2. Hepatitis

3. Pneumonitis

**associated with a 20% mortality rate
**immunization with varicella vaccine has reduced the frequency of this infection in the US
This represents a reactivation of Varicella-zoster virus infection & occurs predominately in adults who previously have had varicella & have circulating antibodies
Herpes Zoster
HOw does Herpes Zoster present?
follows a Dermatomal distribution due to dorsal root ganglion storage

begins with pain along the affected sensory nerve & is accompanied by fever & malaise
-a vesicular eruption then appears in crops confined to the dermatomal distribution & clears in 7-14 days
What is contraindicated when Varicella is suspected? Why?
Ibuprofen b/c of increased risk of Streptococcal Cellulitis
Why should Aspirin be avoided when treating fever in the setting of Viral infection?
to avoid Reye's Syndrome
What may the itching associated with Fifth Disease, Varicella, & Herpes Zoster be treated with?
Oral Antihistamine
What reduces the risk of secondary bacterial infection with a Chickenpox infection?
daily bathing in lukewarm water
What are Immunocompromised children who are exposed to Varicella-zoster given?
VZIG within 96 hours of the exposure & are observed closely
What 2 bacteria cause most bacterial skin infections?
group A Beta-hemolytic streptococci

S. aureus
What causes Bullous Impetigo?
toxin-producing strain of S. aureus
Describe the Bullous Impetigo lesions
Begin as red macules that progress to bullous (fluid-filled) eruptions on a red base
-range from a few mm to a few cm in diameter

After the bullae rupture, a clear, thin, varnishlike coating forms over the denuded area
What can Bullous Impetigo lesions be mistaken for?
Cigarette burns, raising the suspicion of abuse
Describe Nonbullous Impetigo
1. caused by both group A beta-hemolytic + S. aureus

2. begin as papules that progress to vesicles & then to painless pustules measuring approximately 5 mm in diameter with a thin red rim

3. Pustules rupture, revealing a honey-colored thin exudate that then forms a crust over a shallow ulcerated base

4. Lymphadenopathy is common with Strep impetigo (fever is uncommon)
What causes Scalded Skin Syndrome? When does it most commonly occur?
exfoliative toxin-producing isolate of S. aureus

In infancy & rarely occurs beyond 5 yoa
Describe the progression of Scalded Skin Syndrome
1. Onset is abrupt
2. Diffuse redness, marked skin tenderness, & fever
3. Within 12-24 hrs, superficial flaccid bullae develop & then rupture almost immediately, leaving a beefy red, weeping surface
What does a positive Nikolsky sign mean in SSSS?
separation of the dermis on light rubbing
Staphylococcal Scalded Skin Syndrome
What is this?
These begin as superficial folliculitis & are most frequently found in areas of hair-bearing skin that are subject to friction & maceration, especially the scalp, buttocks, & axillae
What is a Carbuncle?
accumulation of furuncles
What is the most common cause of hematogenously spread cellulitis?
Strep pneumoniae
What is limited Nonbullous Impetigo treated with?
topical mupirocin ointment
What are Bullous Impetigo & Nonbullous Impetigo, if numerous, treated with?
First-generation Cephalosporin = Cephalexin
-effective against both Staph & group A Strep


Clindamycin or Trimethoprim-Sulfamethoxazole for MRSA
How is Scalded Skin Syndrome treated?
Mild-Moderate = anti-staph medication

Severe = meticulous fluid management & i.v. Oxacillin or Clindamycin
How is Superficial Folliculitis treated?
aggressive hygeine & topical mupirocin

**exception -- folliculitis of the male beard is treated with oral antistaph drug
How is simple Furunculosis treated?
moist heat
How are large & deep furuncles treated?
Incision & drainage -> topical mupirocin
What is the etiologic agent of Tinea Versicolor?
Malassezia furfur
Tinea Versicolor
Superficial tan or hypopigmented oval scaly lesions on the neck, upper part of the back, chest , & proximal arms in a christmas tree distribution
What is the treatment for Tinea Versicolor?
Selenium Sulfide shampoo or other antifungal agents
What can Diaper Rash result from?
1. Atopic Dermatitis = a form of eczema, is a non-contagious disorder characterized by chronically inflamed skin and sometimes intolerable itching

2. Primary irritant dermatitis

3. Primary or Secondary Candida infections
Topical Nystatin along with Barrier Creams
What is the treatment for Candida Diaper Rash?
What is the cause of Acne Vulgaris?
enlargement of SEBACEOUS GLANDS, increased sebum production, proliferation of Propionibacterium acnes, & secondary inflammation changes
What is the stimulus for Sebaceous gland development & secretion leading to Acne Vulgaris?
Why would you want to differentiate common acne from NOdulocystic Acne?
Latter causes hypertrophic or pitted scarring
This drug works by decreasing the colonization of P. acnes & decreasing the development of microcomedomes by lessening the concentration of free fatty acids
Benzoyl Peroxide
These drugs have strong anticomedogenic activity; however, side efects may limit use & include dryness, burning, & most importantly photosensitivity by reducing the thickness of the stratum corneum layer
Topical Retinoids = TRetinoin, Adapalene, Tazarotene
What must be obtained before initiating treatment of Retinoic Acid for acne?
Pregnancy test within 2 wks of therapy b/c it is a teratogen
-contraception must be used from 1 month prior to 1 month after therapy

Controversial associations of Isotretinoin & mood alterations have also been reported
What is a risk factor for Psoriasis?
HLA type C6
Nonpuritis rash that consists of red papules that coalesce to form plaques with sharply demarcated borders & a silvery or yellow-white scale. The scales tend to build up into layers, and their removal may result in pinpoint bleeding (Auspitz sign)
How do you differentiate b/w Psoriasis & Reiter's Syndrome?
Reiter's Syndrome will have lesion of the mucous membrane
How do you differentiate b/w Psoriasis & Atopic Dermatitis?
Atopic Dermatitis is pruritic & concentrated in flexural creases, whereas psoriasis is not usually pruritic & favors extensor surfaces
What is the treatment management of Psoriasis?
It is characterized by remissions & exacerbations
-educate patient that the disease is chronic & recurrent & cannot be cured but can be controlled
-keep the skin well hydrated
-Tar preps may be added to the daily bath or used as ointment
-Severe cases = natural sunlight or UVB light in conjunction with Tar lubricant
T or F: Psoriasis is pruritic
Acute, self-limited, hypersensitivity reaction that is uncommon in children. Etiologic agents include viral infection (herpes, adenovirus, & Epstein-barr), Mycoplasma pneumoniae infection, drug ingestion (esp Sulfa drugs, immunizations, & food rxns
Erythema Multiforme
Describe the lesions in Erythema Multiforme
Erythematous macules -> Papules -> plaques -> vesicles -> Target lesions

Lesions change over days, not hours

Tend to occur over dorsum of hands & feet, palms & soles, & extensor surfaces of extremities, but may spread to trunk

Burning & itching are common

Systemic manifestations include fever, malaise, & myalgias
What is the most common cause of recurrent erythema multiforme in children?
Herpes Simplex Virus
What is Stevens-Johnson's Syndrome?
Most severe form of Erythema Multiforme
-prodrome of 1-14 days of fever, malaise, myalgias, arthralgias, arthritis, headache, emesis, & diarrhea
-followed by sudden onset of high fever, erythema multiforme skin lesions, & inflammatory bullae of 2 or more mucous membranes
What are the most common causes of Stevens-Johnson Syndrome?
Drugs & Mycoplasma infections
Most severe form of cutaneous hypersensitivity & is similar to Staphylococcal Scalded Skin Syndrome in that both result in sloughing of the epidermal layer
Toxic Epidermal Necrolysis
List the size classifications for Congenital Nevi
Large = > 20 cm
Intermediate = 2-20 cm
Small = < 2 cm
T or F: Giant/Large Nevi have an increased risk of Melanoma
-must be followed annually for changes & may require complete excision