question

Difficult to detect, pale, slightly raised, small papule. Closed comedones - white heads follicular impaction of lipid, keratin, melanin causes the brown or black appearance. Open comedones = black heads - non inflammatory

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Acne vulgaris

question

closed or open comedones become inflamed and evolve into pustules, inflammatory papules, or nodules

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acne vulgaris - propionibacterium acnes (infected)

question

small, painless papule which progresses to black colored vesicle that eventually ruptures producing a painless, blackish, edematous ringed lesion (eschar) - malignant pustule. Farmer/cattleman from western USA at risk.

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Cutaneous Anthrax

question

superficial, intraepidermal lesions which ruptures and forms thin varnish-like light brown crust or a toxic epidermal necrosis of the superficial layers of the skin. Oblique pressure to lesions will cause sloughing off in sheets of skin - bullae.

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Bullous impetigo

question

Following skin abrasions or tinea, intensely inflamed rapidly advancing deep skin infection. advancing edge of the infection may be elevated but it is NEVER sharply indurated or sharply demarcated - systemic signs present (fever, chills, malaise, leukocytosis), often suppurative - after AB treatment symptoms resolve in 1-2 days.

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Cellulitis

question

Superficial infection of the independent follicle and apocrine region of epidermis - small erythematous papule topped by superficial pustule. occurs on any hair bearing site.

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folliculitis.

question

A firm, tender, painful, discrete red nodule about 1 cm in diameter with purulent discharge caused by infection of an individual hair follicle and underlying tissue. skin around lesion is hot but no systemic signs. Peaks in children 3-15yrs old. Neck face axillae buttocks thighs.

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Boils - furuncles.

question

An erythematous, edematous, painful lesion (deeper and larger than furuncle) with a central necrotic crater caused by infection of several hair follicles - extends into subq fat. Lesions coalesce and drain to the surface along hair follicle - fever and malaise present.

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Carbuncle

question

form of non-bullous impetigo extending into the dermis (punched out ulcers with greenish-yellow crust and violaceous margin) suppurative - frequently occurs on legs. Scarring can occur.

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Ecthyma.

question

in superficial epidermis - small vesicles form which develop into pustules with little erythema then rupture with purulent discharge drying on top of the lesion results in thickened amber colored adhesive crust - not associated with a hair follicle.

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Classic impetigo

question

signs and symptoms of either streptococcal pharyngitis or epidemic impetigo - at same time patient has fever, scartiniform rash and charateristic "first white then strawberry" tongue on a person. Rash is blanching, erythematous, sand paper like covering most of the body. first appears on trunk then spreads.

answer

scarlet fever - exotoxin.

question

fever, purulent conjunctivitis, erythematous, dry, fissuring, peeling, bleeding lips. widespread, diffuse erythroderma, progressing to extensive in size and widley distributed in 1-2 days. Followed by total body desquamation - exotoxin mediated.

answer

Ritters Disease/scalded skin syndrome.

question

high fever of 102F, headache, chills, back pain, prostration of 3 days. Next day the fever defervesces and a maculopapular rash appears on face and hands and forearms and then spreads to trunk and legs. 2 days later all the lesions become vesicular and then progress to pustules and eventually scab.

answer

smallpox

question

mild flulike symptoms, mildly pruritic, sparse rash more or less randomly distributed on his trunk, all of which began about 2 days ago. closer inspection reveals the rash now consists of macules, papules, vesicles and crusted lesions. history otherwise unremarkable - child has received all vaccinations.

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Breakthru chicken pox or vaccine-shingles.

question

Prodromal symptoms generally absent, low grade fever, malaise, myalgia, ab pain, anorexia, headache 24-48 hours before lesions. Rash more severe on head and trunk than extremeties. intensely pruritic and evolves within hours. all stages visible at once (maculopapular, papule, vesicles, pustules, and crust).

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Chicken Pox

question

Fever, malaise, headache, and itchy, painful asymmetrical rash. follows a single dermatone. Number of lesions had wide range.

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Shingles.

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in late winter/early spring child manifests with prodrome of mild illness - fever, anorexia, malaise for several days which then evolves to erythematous slapped cheek lacy rash appearing on face. Rash is intense on the face but decreases when going down the body.

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Human parvovirus - erythema infectiosum.

question

late winter/early spring, any person with anemia presents with symptoms of dyspnea fatigue and confusion which has evolved over several days. History reveals patient has been ill before with mild flulike symptoms which persisted for about 3 days. Rash and or arthropathy may be present. Lab results unremarkable except for anemia.

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Human parvovirus - erythema infectiosum

question

late winter/early spring, otherwise healthy adult presents with arthralgias of the hands and wrists - patient had low grade fever, headache, malaise, myalgia, respiratory syndrom and some nausea vomiting and ab pain about a week ago. history with contact with children.

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Human parvovirus - erythema infectiosum.

question

sustained fever of 103-104F for 2-5 days, fever diminishes and then a fine, erythematous blanching macular rash appears on the afebrile child. Peaks in children.

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Exanthem subitum/roseola infantum. HH6

question

prodrome - nonproductive, brassy cough. coryza, conjunctivitis, Koplicks spots on mucosa, vagina, conjunctiva. High fever, lymphadenopathy, pharyngitis then 3-4 days later prodrome continues with blanching, symmetrical rash, on face first then descends lower. Rash clears within 24-72 hours by desquamation.

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Measles, Rubeola.

question

conjunctivitis, coryza, pronounced enlargement of lymphs, pharyngitis, malaise, low grade fever, discrete pink/red macule rash that appears on face and descends. lasts 3-5 days. Peaks in children.

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German Measles

question

NOn itching, non inflammatory, fawn colored depigmentation patches on chest and sometimes pastules, pustules on trunk and or upper arms - resembles acne.

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Pityriasis versicolor.

question

ectothrix on face, head, genital areas - no symptoms. Resembles lice or nits.

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White piedra

question

resembles enothrix of microsporum.

answer

black piedra

question

In florida and other coastal states, female <18 yrs has discrete 1-8cm brown to black mottled macule. Usually on palm or fingers. No inflammation, induration, or scaling.

answer

Tinea nigrans.

question

Spectrum from scales - vesicles - ulcers. Patient has history of itching, inflamed, vesicular crusted lesions.

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Tina pedis, cruris, and barbae. "The big three" (ringworm)

question

leukonchia mycotica (superficial white nail fungus) - nails lose luster and become opaque, brittle, and have crumbling consistency.

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Tinea unguium - dermatophytic onychomycosis.

question

ectothrix - spores produced outside of hair shaft. Fluoresces, infected hair becomes dull and breaks off 3-4mm above scalp.

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Microsporum - Tinea capitis

question

Endothrix spores produced in hair shaft - break at scalp "black dot"

answer

trichophyton - tinea capitis

question

1 or more painless, raised, cutaneous, or subq nodular lesions on the arms that track along draining lymphatics and which later break down and form ulcers. Direct microscopic examination of biopsy show material cigar shaped yeast cells and hyphae. Occurs in people who work with plants.

answer

sporotrichosis.

question

fever, malaise and fatigue, anorexia, nausea, vomiting, diarrhea, dark urine, clay stool, yellow skin+cornea. Increased serum levels of ALT and AST.

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Hepatitis.

question

fever, headache, pharyngitis, lymphadenopathy, hepatosplenomegaly, myalgias, nausea, vomiting, and diarrhea. Rash present. mucotaneous ulcerations in mouth, esophagus, or genitals. Thrush and neurological symptoms

answer

Acute HIV syndrome

question

prodromal symptoms of fever, headache, general malaise, lethargy for 3-5 days, then manifest with enlarged lymph nodes,, erythematous edematous supuurative pharyngitis with high fever lasting for up to 3 weeks. May have rash or liver involvement. Can last 2 months or longer.

answer

Infectious mono

question

insidious onset of fever, which increases stepwise over a week to 104F with headache, anorexia, lethargy, malaise, prostration, aches and pains, cough, intestinal signs. Second week temperature may be sustained plus mental dullness, apathy, splenomegaly, leukopenia. Rose spots may appear. Fever subsides in 3rd week.

answer

typhoid fever

question

flu like illness, lasting 3-4 days then fever, headache, blanching macular rash on wrist and ankles. then spreads to trunk as well as hands and feet (including soles), rash if untreated can progress to petechial then purpuric lesions. High mortality if left untreated.

answer

Rocky mountain spotted fever

question

systemic signs and symptoms followed by abrupt onset of fever, headache, blanching maculo rash, which spreads centrifugally sparing face, palms, and soles. rash lasts 4-7d and can evolve to petechial if untreated. mortality without treatment is high.

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louse-borne epidemic typhus. recrudescence causes milder infection - brill-Zinserr disease

question

Petechial, non blanching rash on trunk, thighs, feet, ankles and forearms - present if septicemia occurs.

answer

Meningococcemia.

question

Recurring cycles of 4 days symptomatic then 4 days asymptomatic. Rash, malaise, night sweats, bone pain, increase in severity with each recurrence.

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Trench fever

question

patient manifests with fever and regional lymph node enlargement. Had exposure to cat.

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Cat scratch fever

question

prolonged course of flulike symptoms, large circular rash with central cleared area which resolves slowly. Lesion is self limiting.

answer

lyme disease

question

patient presents with episode of pain and swelling in left knee of 1 week duration. this is the third episode in 2 months. each previous episode also lasted about 1 week and involved both knees. was on hiking trip in NY 3 months earlier when fever/bulleye rash appeared.

answer

Lyme disease stage 2

question

prodrome of flu like symptoms followed by paroxsyms (chills, high fever, rigor) lasting about 12 hours. Fever rapidly diminishes and patient is soaked by drenching sweats. Patient is aymptomatic until prodrome and paroxysms appear every 4 days. Recently returned from Africa.

answer

Malaria.

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