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2-20-04
DERMATOLOGY

PIC:
Stasis Dermatitis
• Erythema, hyperpigmentation, and scale occurring on the distal lower extremities, particularly over the medial malleolus
• Stasis dermatitis is frequently preceded by chronic and recurrent edema of the lower legs

1. Vinette:
Pt w/o TX whould have a progosis with lrg tortuous vericose veins high vol. Venous reflux & early stasis changes of medial ankle.
Answer: - Venous ulceraton

2. Vignett:
Pt with lrg varicosities above the knee
Answer: Venous ulceration (takes a while to take place)
- Constant irrition could produce a squamous cell CA

Palms/Soles:
- TSS – 15y/o female
- Secondary Sphyllis
- Kwasaki
- Rocky Mt. Spotted Fever
-
If you culture a Strep bovis – Think Colon CA

• Meningococcemia:
o Emergent

• ID-RASH DZ:
a. Lyme Dz
- Taget rash
- Look for Long Island Conn.
- Rash – erythema chronicum migrans
b. 5th Dz
- erythema infectiosum
- Rash “slapped cheek”
- Parvovirus B12, can cause aplastic anemia
- Test for Ab
c. Measels (rubeola)
- cough, roryza, conjunctivitis, Koplik
- rash accoumpanied by fever for measels
- Roseola – rash after fever
- Rubella – 3rd measels, lymphadenopathy
- Can immunize against measels, rubella, Lyme
d. Rocky Mt. Spotted Fever
- Look for Carolina’s
- Rash palms/feet
- Cat-scratch fever – papule, granuloma, lymphadenitis
- PCR most senstitive for Dx
- Kittens transmit more than cat
e. Rheumatology
- Juv. RA
Types:
- polyarticular- many, small joints, RF - , RF +
- Pauciarticular – fw lrg joints
- Type I – ANA+
- Rash, systemic fever
f. SLE
- Malar rash “wolf”
- Reanal involvement in child
- BX – for immunoflorescence
- Neonatal lupus – congenital heart block
g. Kwasaki
- Mucocutaneous lymph node syndrome
- Fever plus 4 to 5 following:
o Conjunctivitis mucous membrane changes
o Peripheral extremity changes
o Rash (rash peeling on hands & feet “dequamation”)
o Cervical lymph nodes
o Cardia involvement...

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