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62 Cards in this Set

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Macule
Flat, non-palpable  lesion that differs from surrounding skin only by color <5mm
Flat, non-palpable lesion that differs from surrounding skin only by color <5mm
Papule
Solid, raised lesion, lesion less than 1cm in diameter
Solid, raised lesion, lesion less than 1cm in diameter
Nodule
Raised, palpable
Deeper in dermis 

Similar to papule but located deeper in the dermis or subcutaneous tissue; differentiated from papule by palpability and depth, rather than size
Raised, palpable
Deeper in dermis

Similar to papule but located deeper in the dermis or subcutaneous tissue; differentiated from papule by palpability and depth, rather than size
Plaque
Raised, flat top
Larger than 1cm in diameter
Raised, flat top
Larger than 1cm in diameter
Pustule
Pus-filled papule 


Circumscribed elevation of skin containing purulent fluid of variable character (i.e., fluid may be white, yellow, greenish or hemorrhagic)
Pus-filled papule


Circumscribed elevation of skin containing purulent fluid of variable character (i.e., fluid may be white, yellow, greenish or hemorrhagic)
Vesicle
Fluid filled papule 


Circumscribed, elevated, fluid-containing lesion less than 0.5 cm in greatest diameter; may be intraepidermal or subepidermal in origin
Fluid filled papule


Circumscribed, elevated, fluid-containing lesion less than 0.5 cm in greatest diameter; may be intraepidermal or subepidermal in origin
Bulla
A cyst larger than 1cm in size
A cyst larger than 1cm in size
Cyst
Raised, fluid filled sac
Raised, fluid filled sac
Open Comedone
Blackhead
Blackhead
Closed Comedones
White Head
White Head
Tumor
A large nodule


Picture of NF
A large nodule


Picture of NF
Wheal
Edematous, slightly raised 

Firm, edematous, flat topped papue or plaque resulting from infiltration of dermis with fluid that lasts <24hrs.

Uticaria
Edematous, slightly raised

Firm, edematous, flat topped papue or plaque resulting from infiltration of dermis with fluid that lasts <24hrs.

Uticaria
List secondary dermatologic terms
- scale
-crust (hemorrhagic or moist)
- excoriated (scratched, rubbing)
- oozing
erosion
ulceration
Board Buzz Words:

Slapped Cheeks
Erythema Infectiosum (fifth disease)
Erythema Infectiosum (fifth disease)
Erythema Infectiosum (fifth disease)
Cause:
Incubation:
Prodrome:
Cause: Parvovirus B19

Incubation: 4-14 days but can be up to 21 days

Prodrome: Mild URI symptoms for 2-3 days with rash 7-10 days later
Erythema Infectiosum:

Characteristics of Rash
Slapped Cheeks with circumoral pallor

Maculopapular eruption (lace-like) on proximal extensor surfaces of extremities and often to trunk, neck and buttocks, palms/soles are spared
Erythema Infectiosum:

Complications
Arthritis, aplastic crisis, fetal infection- hydrops fetalis (overall risk of fetal death 1-9%)
Boards Buzz:

What diagnosis would be appropriate for an infant with high fever followed by diffuse rash after fever subsides
Roseola
Roseola :

Cause:
Incubation:
Prodrome:
Peak Age:
Cause: Human HerpeseVirus 6
Incubation: 5-15 days
Prodrome: During period of high fever (3-4 days prior to inset of rash)
Peak Age:6months to 3 years
Roseola:

Characteristics of Rash
Generalized erythematous, maculopapular rash;
Starts on trunk and spreads to arms and neck with less involvement of face and legs; TRUNK FIRST
Color: Pink-Red
Duration: 2 days
Suboccipital Lymphadenopathy
Roseola:

Complications
Febrile Seizure
Boards Buzz:

Sandpaper rash and strawberry tongue
Scarlet Fever
Scarlet Fever:
Cause:
Incubation:
Prodrome:
Cause: GABHS
Incubation:3-5 days following pharyngitis or skin infection
Prodrome: 12 hours to 2 days; fever, pharyngitis, vomiting
Scarlet Fever:

Characteristics of Rash
Erythematous, sandpaper texture, starts on neck, axillae, ingunal areas then spreads to rest of body

Petechiae in antecubital and axillary skin folds (Pastia’s lines) are helpful in making diagnosis


Lasts 7 days then desquamates; Strawberry tongue
Scarlet Fever:

Complications
Management
Complications: Rheumatic fever, acute glomerulonephritis

Management: Penicillin first line, erythromycin, cephalexin, or azithromycin for PCN allergic, augmentin for treatment failures
Aplastic crisis is a complication of what condition?
What is the etiology of Roseola?
What is the treatment for GAS pharyngitis/scarlet fever in PCN allergic pt?
What specific lymphadenapathy can be present in Roseola?
Aplastic crisis is a complication of what condition?
- Erythema Infectiosum
What is the etiology of Roseola?
-Herpesvirus 6
What is the treatment for GAS pharyngitis/scarlet fever in PCN allergic pt?
-erythromycin, cephalexin, azithromycin
What specific lymphadenapathy can be present in Roseola?
-suboccipital
Hand, Foot, and Mouth Disease:
-Causes
-Incubation
-Transmission
- Prodrome
Causes: Enteroviruses: Coxsackie virus a16, a5, a10
Incubation: 4-6 days
Transmission: Exposure through enteric route: oral-oral, oral-fecal), highly contagious
Prodrome: 1-2 days before rash, low-grade temperature, sore throat/mouth, malaise, lymphadenopathy
Hand, Foot and Mouth Disease:

Characteristics of Rash
Aphthae-like lesions anywhere in the mouth, followed by 3-7mm red macules on palms and soles
Lesions on palms/soles develop into cloudy vesicles with red halos
Can also see mild peri-orbital edema
Boards Buzz Words:

"desquamating rash, strawberry tongue, and dry, cracked lips"
Kawasaki's Disease
Kawasaki's Disease:
Description
Prodrome
Mucocutaneous lymph node syndrome

Prodrome: Abrupt, high spiking fever (101-104 F) for 5 days!!!!! unresponsive to anti-pyretics
Occasionally diarrhea, cough, or abdominal pain
Kawasaki's:

Characteristics of Exanthem
Within 3 days of fever
Bilateral bulbar conjunctival congestion

Erythematous mouth and pharynx with strawberry tongue and red, cracked lips

Cervical lymphadenopathy

Generalized rash - morbilliform, maculopapular, scarlatiniform or may resemble erythema multiforme
Kawasaki's:

Complications?
Management?
Echo dates?
Complications: arthritis, meningitis, coronary aneurysm (20-25%)

Management: supportive care, anti-inflammatories, (IVIG and Aspirin) within first 10 days after fever

Hospital Admission, serial echo (at diagnosis, 2wks, 6-8wks, 6-12 months)
Boards Buzz:

Recent febrile illness without specific identifying sx and non-specific rash
Non-specific Viral Exanthem

Viral Exanthem Not Otherwise Specified
What are presentations of Viral Exanthems NOS?
Morbilliform or rubelliform
Vesicular
Petechial (typical of echovirus 9)
urticarial
Which enterovirus is responsible for Hand, Foot, and Mouth disease?
Coxsackie virus a16, a5, a10
What is the pharmacologic therapy recommended in Kawasaki’s disease?
IVIG, Aspirin
Which disease may have a rash that resembles EM or scarlatina?
Viral Exanthem NOS
Chicken Pox (Varicella Zoster) :

Incubation
Prodrome
Incubation: 10-20 days

Prodrome: malaise low grade fever
Varicella Zoster

Characteristics of Rash
Develops over 3-6 day period, usually starts at hairline or face

Lesions begin as macule, papule, vesicle, then crusted vesicle

Rash emerges in crops over trunk, finally the extremities
Chicken Pox:

Complications
Management
Complications: bacterial infection of vesicular lesions, pneumonia, hepatitis, arthritis, glomerulonephritis, CNS disease
Management:
Cut nails to prevent scratching
Wash lesions BID with soap and water
Benadryl, cold washcloth/oatmeal baths
Acyclovir for high risk/immunocompromised
Boards Buzzwords:

pearly, umbilicated, dome-shaped lesions
Molluscum Contagiousum
Molluscum Contagiousum:
Transmission
Appearance
Transmission: Spread by direct skin-skin contact, autoinoculation by scratching or touching a lesion
Can spread by contact sports or fomites


Dome-shaped, often umbilicated, translucent to white papules, 1mm-1cm, with tiny keratotic core
Often surrounded by scaling and erythema that resemble eczema
May appear inflamed and secondarily infected when undergoing spontaneous involution
Molluscum Contagiousum:
Complications

Management
Complications: secondary infections, cosmetic issues, widespread infection in immunocompromised

Management: self-limited (most resolve in 6 months up to 4 years), curettage, cryotherapy, laser therapy, imiquimod, potassium hydroxide, cantharidin, Retin-A
Boards Buzz:

Intertriginous, linear, severely itchy
Intensely puritic rash in webs of finger
Scabies


mite Sarcoptes scabiei
results in an intensely pruritic eruption (itching worse at night) with a characteristic distribution pattern
Transmission is person-person/direct contact
Hypersensitivity reaction to mite, feces, and eggs
Scabies:

Characteristics of Rash
small, erythematous, nondescript papule, often excoriated and tipped with blood crusts

burrow is a thin, grayish, reddish, or brownish line that is 2 to 15 mm, often absent or obscured by excoriation or secondary infection

Miniature wheals, vesicles, pustules, and rarely bullae may also be present
Scabies:
Characteristics of Distribution
sides and webs of the fingers

flexor aspects of the wrists, the extensor aspects of the elbows

the skin immediately adjacent to the nipples (especially in women)

the periumbilical areas, waist, male genitalia (scrotum, penile shaft, and glans)

back is relatively free of involvement, and the head is spared except in very young children
Scabies:
Management
Management: topical permethrin, oral ivermectin, antihistamine or topical steroid for itching, transmission control (treat close contacts simultaneously
Tinea Capitus:

AKA
description
complication:
- "ringworm of the scalp,"
- primarily affects school-aged children
one or more annular patches of inflammatory or noninflammatory alopecia
Complicaitons: Kerion, a severely inflammatory, boggy, indurated, tumor-like mass that may occur in tinea capitis.
Tinea Capitus:

management
Griseofulvin for 8 weeks

Shampoo with selenium sulfide 2-3x per week or ketoconazole
Tinea Corporis:

Classic Presentation
classic presentation - circular plaque with a well-demarcated red, scaly border, with central clearing
Tinea Corporis:

Management
Topical Antifungals: Clotrimazole, Miconazole, Ketoconazole; may take up to 8 weeks

Oral if recurrent, unresponsive: Griseofulvin
Tinea Pedis:

aka
presentation
Management
Athletes Foot

Presentation: white, macerated areas in toe webs or chronic dry, scaly hyperkeratosis of the soles and heels

MGMT: topical therapy (Lotrimin, Nyzoral), oral agents provide better skin penetration than most topical preparations: Itraconazole, terbinafine and griseofulvin are good choices for oral therapy
How do you diagnose and Tinea infection?
KOH scraping of lesion boarders confirms hyphea and spores

Dermatophyte test medium: Confirms diagnosis
Infantile Atopic Dermatitis:

Common Locations
infantile stage may present with pruritic, red, scaly, and crusted lesions on the EXTENSORE SURFACES and CHEEKS or SCALP

acute lesions can include vesicles and there can be serous exudate in severe cases
Childhood Atopic Dermatitis:
often demonstrates lichenified plaques in a flexural distribution, especially of the ANTECUBITAL and POPLIEAL FOSSAE, volar aspect of the WRISTS, ANKLES, and NECK
BUZZWORDS:

Rash on earlobes or front of abdomen under waistband
Allergic contact dermatitis (ACD) -localized pruritic dermatitis after exposure to a contact allergen
The configuration and location of the dermatitis often is a clue to the offending allergen

Acute – vesicles/bullae filled with clear fluid, erythematous/edematous skin

Chronic – lichenified plaques with minimal erythema, minimal edema, possible scales
An 8 y/o white male present with a 4-day h/o erthematous cheeks. Examination of the extremities reveals a mildly pruritic, reticulated, erythematous, maculopapular rash. The most likely etiologic agent is:

Human parvovirus
Adenovirus
Cytomegalovirus
Coxsackievirus
Human parvovirus
The most appropriate initial treatment for scabies in an 8 y/o male is:
0.5% malathion lotion
5% permethrin cream
5% precipitated sulfur in petroleum
Trimethoprim/sulfamethoxazole orally for 10 days
5% permethrin cream
A 4 y/o male has a fever of 1 wk duration around 101o F that has responded poorly to Tylenol. He has a sore throat and his lips are cracked and red. He has anterior cervical lymphadenopathy and he palms and soles are erythematous. The most appropriate management at this time would be:


Intramuscular Bicillin L-A 600,000 units
Intravenous nafcillin
Intravenous immune globulin and ASA
Prednisone, 2-3mg/kg/day
A fine-needle biopsy of the lymph nodes
Intravenous immune globulin and ASA
Maternal parvovirus poses which of the following risks to the fetus?

Hydrops
Laryngeal papillomas
Chronic active hepatitis
Seizures
Pneumonia
HYDROPS
The primary reason for treating uncomplicated scarlet fever is to:

Reduce the severity of acute symptoms
Reduce the incidence of subsequent rheumatic fever
Reduce the risk of poststreptococcal glomerulonephritis
Prevent peritonsillar abscess
Shorten the duration of illness
Reduce the incidence of subsequent rheumatic fever
An 8 month old infant is brought to clinic by her mother with 1 week history of fever and runny nose. The mother reports that the fever “broke” yesterday, but the child awoke with a rash this morning. The rash is shown below. All of the following statements regarding the child’s condition are true except:


Associated febrile seizures are uncommon
It is caused by a herpes virus
Suboccipital LAD may be present
Rash is initially present on chest then spreads to extremities
Associated febrile seizures are uncommon