Term
| A crust (dried serum or blood) should lead you to think of ___ as the primary disorder. |
|
Definition
|
|
Term
| Causes of vesicles and bullae: |
|
Definition
- bacteria
- viruses
- contact dermatitis
- autoimmune disorders
- metabolic disease |
|
|
Term
| Blister ___ is very important in determining etiology. |
|
Definition
|
|
Term
| Intraepidermal blisters suggest __ __ or __ __. |
|
Definition
- contact dermatitis
- pemphigus vulgaris |
|
|
Term
| Subepidermal blisters suggest __ ___, __ ___, or ____. |
|
Definition
- bullous pemphigoid
- dermatitis herpetiformis
- porphyrias |
|
|
Term
| Subepidermal blisters are more ___, while intraepidermal blisters are more ___. |
|
Definition
|
|
Term
| Intraepidermal eruption caused by a medium sized DNA virus that replicates within the nucleus: |
|
Definition
Herpes Simplex (HSV)
- greater than 50% (some sources say 90%) are serum positive for HSV-1
- greater than 20% serum positive for HSV-2 |
|
|
Term
| May see systemic symptoms like fever, malaise, headache, and regional adenopathy. Prodome starts within 24 hours before eruption in 2/3 of patients. |
|
Definition
Herpes Simplex
Male to female transmission risk – 80 to 90%
Risk of recurrence
HSV-1: 14%
HSV-2: 60% |
|
|
Term
| grouped vesicles on an erythematous base, may become necrotic: |
|
Definition
|
|
Term
| Herpes simplex infection of the fingers is called __ __. This is seen in with dental and medical professionals. |
|
Definition
|
|
Term
| Herpes simplex infection in wrestlers is called __ ___. |
|
Definition
|
|
Term
| Herpes simplex infections in predisposed skin (like skin with atopic dermatitis) is called : |
|
Definition
| eczema herpeticum- can be fatal |
|
|
Term
| To diagnose HSV do a __ __ and look for __ __ __. |
|
Definition
- Tzanck smear
- multinucleated giant cells |
|
|
Term
|
Definition
- impetigo
- contact dermatitis
- superficial fungal infection |
|
|
Term
| Treatment of HSV does not prevent __ ___. |
|
Definition
| does NOT prevent recurrent infection |
|
|
Term
|
Definition
First episode
Acyclovir 200mg five times daily or 400mg t.i.d. for 7-10 days.
Valacyclovir 1000mg b.i.d. for 10 days
Famciclovir 250mg t.i.d. for 7 days
Suppressive
Acyclovir 400mg b.i.d.
Valacyclovir 500mg or 1g daily
Famciclovir 250mg b.i.d. |
|
|
Term
| Herpes simplex has an incubation period of __ __ and the eruption usually lasts __ __, following with another __ __ of crusting, ulceration, and healing. Recurrences have shorter courses of __ to __ weeks. |
|
Definition
- one week
- 10 days
- 10 days
- 1-2 weeks |
|
|
Term
| Triggers for recurrences of HSV: |
|
Definition
- fever
- UV light
- physical trauma
- menstruation
- emotional stress |
|
|
Term
| Neonatal herpes has a __ mortality rate when not treated, and __ of those treated have a serious neurological problems. A __ __ is recommend for active HSV infection. __ of women who have babies with neonatal HSV have no history of infection. |
|
Definition
- 50%
- 50%
- C-section
- 70% |
|
|
Term
| __ ___ may follow neonatal HSV infection. |
|
Definition
|
|
Term
| HSV was found in __ of saliva and ___ on hands of actively infectious individuals. This virus remains viable on skin, clothes, and plastic for ___ ___. |
|
Definition
|
|
Term
| Vesicular dermatomal eruption caused by recrudescence of latent varicella-zoster virus in patients who have had varicella, Virus dormant within the sensory ganglia of the spinal cord |
|
Definition
Herpes Zoster (shingles)
Incidence
10-20% lifetime risk
Higher incidence in HIV, Hodgkin’s
History
Burning, electrical, or shooting pain
May mimic migraine, pleurisy, MI, or appendicitis |
|
|
Term
| Herpes zoster diagnosis is usually ___, though __ ___ smears are the most sensitive test. |
|
Definition
- clinical
- direct immunofluorescence |
|
|
Term
|
Definition
Pain control
Topical
Amitriptyline 50-100mg daily for post-herpetic nueralgia
Oral or IV antivirals
Best administered within first 24-72 hours
Acyclovir 800mg five times daily for 7 days
Valacyclovir 1g t.i.d. for 7 days
Famciclovir 500mg t.i.d. for 7 days
Oral steroids
Judgment call
Best indicated for trigeminal involvement and to prevent post-herpetic neuralgia |
|
|
Term
|
Definition
- macules> vesicles> pustules> crusting
- healing within 2-3 weeks |
|
|
Term
| Post-herpetic neuralgia incidence increases with __, __ gender, __ presence, or more severe acute pain and eruption. 80% of patients with post-herpetic neuralgia are asymptomatic in 12 months. |
|
Definition
- age
- female gender
- prodrome |
|
|
Term
| Herpes opthamalicus affects the __ branch of the ___ division of the __ nerve. It involves the __ of the __ and scarring of the __ may occur. |
|
Definition
- nasociliary branch of the opthalmic division of the trigeminal nerve
- tip of the nose
- conjuctiva |
|
|
Term
| Intraepidermal vesicular eruption caused by a virus. 2-3 week incubation period. 2-3 weeks of prodrome of fever, chills, malaise, headache, sore throat, anorexia, dry cough. Infectious until all lesions have become crusted. |
|
Definition
| Varicella= chicken pox (caused by varicella zoster virus) |
|
|
Term
| 90% of varicella cases occur before the age of __. Peaks in __, __, and __. This is more serious in adults and can cause pneumonia. |
|
Definition
|
|
Term
| Grouped, cloudy and hemorrhagic vesicles on an erythematous base in a dermatomal distribution: |
|
Definition
|
|
Term
| Dewdrop vesicle on a rose pedal erythematous base: |
|
Definition
| Varicella zoster (chicken pox) |
|
|
Term
| Varicella zoster progression: |
|
Definition
- macules> vesicles> pustules> crusting
- generalized pruritic eruption most prominent on the trunk
- successive crops of rapidly progressing lesions over an 8-12 day period
- ALL LESIONS PRESENT AT SAME TIME
- often umbilicated or hemorrhagic
- dewdrops on a rose pedal appearance |
|
|
Term
| To diagnose varicella zoster you could do a __ __ where you would see __ __ __. |
|
Definition
- Tzanck smear
- multinucleated giant cells |
|
|
Term
| A varicella infection during pregnancy has a ___% of being vertically transmitted to baby. |
|
Definition
|
|
Term
| A person with varicella should NOT take ___ b/c it could cause Reye's Syndrome. |
|
Definition
|
|
Term
|
Definition
Antihistamines and topical agents
Vaccine safe in children and healthy adults |
|
|
Term
| __ ___ __ is effective in preventing or modifying infection in immunodeficient patients shortly after exposure. |
|
Definition
| Varicella-zoster immune globulin (VZIG) |
|
|
Term
| Intraepidermal/subcorneal infection caused by certain strains of Staph. aureus. Results in clear or cloudy bullae on the face/neck/extremities and regional adenopathy. |
|
Definition
|
|
Term
| Bullous impetigo is caused by strains of __ __. It is most common on the __, __, and __. May see regional adenopathy. |
|
Definition
- S. aureus
- face, neck, extremities |
|
|
Term
| Bullous impetigo differential diagnosis: |
|
Definition
Contact dermatitis, HSV, superficial fungal infections, pemphigus vulgaris
Staphylococcal scalded skin syndrome
Sudden onset of fever, skin tenderness, and erythema followed by large flaccid bullae eventually leading to a large denuded surface
Sterile bullae
Source of infection – conjunctiva, nose, pharynx, umbilical stump |
|
|
Term
| Sudden onset of fever, skin tenderness, and erythema followed by large flaccid bullae eventually leading to a large denuded surface |
|
Definition
| Staph scalded skin syndrome |
|
|
Term
| Bullous impetigo therapy; |
|
Definition
Therapy
Cephalexin 25-50mg/kg daily in oral suspension or 500mg b.i.d.
Erythromycin 500mg b.i.d.
Dicloxacillin 500mg b.i.d.
Antibacterial soaps – Lever 2000, Dial, Hibiclens
Course and complications
Heals within 3-6 weeks without treatment |
|
|
Term
|
Definition
| nails, nares, naval, natal cleft ( I think) |
|
|
Term
| linear streaking pattern: |
|
Definition
|
|
Term
| positive Nikolsky's sign: |
|
Definition
- extension of blister with lateral pressure
- positive with Pemphigus Vulgarus |
|
|
Term
| Flaccid intrepidermal blisters above the basal layer. Blistering of skin AND MUCUS MEMBRANES. Positive Nikolsky's sign. |
|
Definition
|
|
Term
| Pemphigus vulgaris has a __ mortality rate without treatment. |
|
Definition
- high
Overall mortality rate now 8-10%. |
|
|
Term
Pemphigus vulgaris treatment:
(this is an autoimmune reaction) |
|
Definition
Methotrexate
Cyclophosphamide
Azathioprine
Mycophenolate mofetil
Gold |
|
|
Term
| Autoimmune disorder in the elderly resulting in large tense subepidermal blisters. Negative Nikolsky's sign. Most commonly in the groin, axilla, and flexural surfaces. |
|
Definition
|
|
Term
| Bullous pemphigoid treatment: |
|
Definition
| May treat with oral steroids (add bisphosphonate), tetracycline, or other immunosuppressives |
|
|
Term
| Tense bullae on noninflammatory skin and crusted residual bullae: |
|
Definition
|
|
Term
| __ __ has flaccid intraepidermal blisters that also effect the mucus membranes, while ___ ___ has tense blisters that do NOT effect mucus membranes. |
|
Definition
Pemphigus vulgaris
Bullous pemphigoid |
|
|
Term
| Intensely pruritic vesicular eruption characterized by grouped papules, vesicles (usually not intact), and urticarial plaques that are symmetrically distributed on the elbows, knees, buttocks, lower back, and shoulders. Subepidermal blisters. |
|
Definition
|
|
Term
| 75% of patients with __ __ also have gluten sensitivity. |
|
Definition
|
|
Term
| Dermatitis herpetiformis treatment: |
|
Definition
| Clears rapidly after treatment with dapsone (check G6PD level before starting) or sulfapyridine |
|
|
Term
| crusted vesicles on the elbows and knees, symmetrically: |
|
Definition
|
|
Term
Excessive uroporphyrin excretion in urine
Uroporphyrin:coproporphyrin ratio greater than 3:1 |
|
Definition
Porphyria Cutanea Tarda
(most common form of porphyria) |
|
|
Term
| Subepidermal blisters on hands, mottled facial pigment, excess facial hair on temples and cheeks. May be seen in patients with liver problems. |
|
Definition
|
|
Term
| tense hemorrhagic bullae on the dorsum of hand: |
|
Definition
|
|
Term
| Porphyria cutanea tarda is often precipitated by alcohol consumption, hepatitis C, or ___. It is associated with hereditary ___. Treatment includes ___ and ___. |
|
Definition
- hormones (BCP)
- hereditary hemochromatosis
- antimalarials and phlebotomy |
|
|
Term
| Blistering limited to the hands and feet caused by a dominant keratin gene mutation. |
|
Definition
| Epidermolysis Bullosa Simplex |
|
|
Term
| Epidermolyis bullosa simplex is caused by a ___ ___ gene mutation. Treatment is symptomatic, wound care and protection from trauma. |
|
Definition
|
|
