Lecture 6 Part 2
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Questions and Answers

What is the primary manifestation of the first stage of Lyme disease?

  • Erythema multiforme
  • Erythema migrans (correct)
  • Blisters
  • Lesions on limbs

How long after a tick bite can Lyme disease symptoms typically appear?

  • 24 hours to one week
  • Two days to two weeks (correct)
  • One week to two weeks
  • One month to two months

Which areas are primarily affected by hyperhidrosis?

  • Neck, face, and chest
  • Knees, elbows, and wrists
  • Back, abdomen, and thighs
  • Palms, soles, and axillae (correct)

What is the causative agent of Lyme disease?

<p>Borrelia burgdorferi (D)</p> Signup and view all the answers

What is the main first-line treatment for hyperhidrosis?

<p>Aluminum chloride (D)</p> Signup and view all the answers

Which treatment is commonly used for Lyme disease?

<p>Doxycycline (C)</p> Signup and view all the answers

In patients with predominantly emotional hyperhidrosis, which part of the brain shows overactivity?

<p>Cortical centers (C)</p> Signup and view all the answers

What condition is EM commonly associated with as an underlying disease?

<p>Herpes simplex (A)</p> Signup and view all the answers

What characterizes the lesions of Erythema Multiforme?

<p>Red papules that develop into target lesions (A)</p> Signup and view all the answers

What do keloids and hypertrophic scars have in common?

<p>They are both examples of excessive scar formation. (A)</p> Signup and view all the answers

How is the diagnosis of Lyme disease primarily confirmed?

<p>ELISA and Western blot (A)</p> Signup and view all the answers

What type of hyperhidrosis is characterized by sweating primarily due to emotional stress?

<p>Emotional hyperhidrosis (A)</p> Signup and view all the answers

Which combination of treatments could be considered if aluminum chloride is ineffective?

<p>Referral to a dermatologist and anxiety medication (A)</p> Signup and view all the answers

What is the best treatment for Erythema Multiforme once it appears?

<p>Antihistamines and NSAIDs (A)</p> Signup and view all the answers

Which group of patients is more prone to developing keloids?

<p>African-Americans (D)</p> Signup and view all the answers

What type of hyperhidrosis is characterized by continuous sweating regardless of emotional triggers?

<p>Continuous axillary hyperhidrosis (D)</p> Signup and view all the answers

Which locations are most commonly affected by striae during puberty in males?

<p>Thighs, lower back, and upper back/shoulders (A)</p> Signup and view all the answers

What is a key indicator that striae may be related to a pathologic state?

<p>Striae in unusual locations occurs (D)</p> Signup and view all the answers

What is the most common type of herpes virus responsible for genital herpes?

<p>HSV-2 (D)</p> Signup and view all the answers

Which of the following is a common symptom that precedes the appearance of herpes lesions?

<p>Pain, burning, and tingling (C)</p> Signup and view all the answers

What is a limitation of treating striae effectively?

<p>Lack of effective treatment options exists (A)</p> Signup and view all the answers

What percentage of the population has antibodies for HSV-1?

<p>80-90% (A)</p> Signup and view all the answers

Which factor is NOT typically associated with stimulating herpes viral activation?

<p>Medical intervention (C)</p> Signup and view all the answers

What characteristic distinguishes a keloid from a hypertrophic scar?

<p>Keloids extend laterally beyond the borders of the initial wound. (C)</p> Signup and view all the answers

What typically happens to the lesions after vesicles from a herpes outbreak rupture?

<p>A painful superficial ulcer often remains (D)</p> Signup and view all the answers

Which factor increases the likelihood of developing a keloid or hypertrophic scar?

<p>Inflammation or infection at the wound site (D)</p> Signup and view all the answers

What is the primary treatment approach for both keloids and hypertrophic scars?

<p>Massage therapy combined with steroid injections (B)</p> Signup and view all the answers

Where are keloids and hypertrophic scars more likely to occur?

<p>On the earlobes and central chest (B)</p> Signup and view all the answers

What role does transforming growth factor beta (TGF-β) play in scar development?

<p>It promotes production of extracellular matrix components. (D)</p> Signup and view all the answers

How do striae distensae typically progress in appearance over time?

<p>Their color fades to a linear depression. (B)</p> Signup and view all the answers

During which life stage are striae most commonly observed in individuals?

<p>Puberty and pregnancy (D)</p> Signup and view all the answers

What is a common symptom associated with striae distensae?

<p>Mild itchiness (A)</p> Signup and view all the answers

What is the primary reason for using suppressive therapy with valacyclovir in patients with recurrent EM outbreaks?

<p>To prevent HSV outbreaks. (C)</p> Signup and view all the answers

Which HPV types are most commonly associated with genital warts?

<p>HPV types 6 and 11 (C)</p> Signup and view all the answers

What characteristic is least associated with the appearance of genital warts?

<p>Presence of dark dots from dilated capillary loops (B)</p> Signup and view all the answers

Which patient population is at increased risk for developing genital or anal carcinoma associated with genital warts?

<p>Transplant recipients with suppressed immunity (B)</p> Signup and view all the answers

In which age group is it least likely that genital warts in children are a sign of sexual abuse?

<p>Under 3 years old (D)</p> Signup and view all the answers

What is a significant risk associated with perianal warts in individuals who engage in receptive anal intercourse?

<p>Higher association with anal carcinoma (D)</p> Signup and view all the answers

Which of the following best describes the nature of HPV following the spontaneous resolution of genital warts?

<p>HPV may enter a latent, subclinical state. (D)</p> Signup and view all the answers

What type of therapies can be used for the treatment of genital warts?

<p>Both destructive and immunity-based therapies (A)</p> Signup and view all the answers

What is the primary cause of Tinea Versicolor?

<p>Overgrowth of yeast (B)</p> Signup and view all the answers

Which area of the body is least affected by Tinea Versicolor lesions?

<p>Lower arms (A)</p> Signup and view all the answers

What is a common treatment for Tinea Versicolor?

<p>Ketoconazole shampoo (D)</p> Signup and view all the answers

Which population is most commonly affected by Tinea Versicolor?

<p>Individuals of Mediterranean descent (D)</p> Signup and view all the answers

What symptom is most commonly associated with Pediculosis Pubis?

<p>Severe pruritus in the genital region (A)</p> Signup and view all the answers

What is the primary characteristic of Phthirus pubis?

<p>Short and wide body (A)</p> Signup and view all the answers

What should be avoided in the treatment of Tinea Versicolor due to poor effectiveness?

<p>Allylamines (D)</p> Signup and view all the answers

How long can it take for pigmentation to return to normal after curing Tinea Versicolor?

<p>Several months (C)</p> Signup and view all the answers

Flashcards

Hyperhidrosis

A condition characterized by excessive sweating, commonly affecting palms, soles, and armpits.

Emotional Hyperhidrosis

Sweating triggered by emotional stress or anxiety, often affecting palms and soles.

Continuous Hyperhidrosis

Continuous sweating, often affecting armpits, caused by overactive hypothalamic centers.

Aluminum Chloride

First-line treatment for hyperhidrosis involving a substance that blocks sweat glands, often 25% aluminum chloride.

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Keloid

Excess scar tissue that extends beyond the original wound boundaries, more common in people of African descent.

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Hypertrophic Scar

Excess scar tissue that remains within the original wound boundaries, equally common in all races.

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Eccrine Gland

A type of sweat gland that produces a watery sweat in response to heat or emotional stress.

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Scar

Elevated areas of scar tissue, often firm and rubbery to the touch. They can be caused by injuries, burns, or surgery.

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Striae

Stretch marks that occur when the skin's tension exceeds its elasticity.

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Cushing's disease

A condition characterized by excessive cortisol production, leading to weakened skin and increased susceptibility to striae.

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Primary Herpes Infection

The initial, most severe outbreak of herpes infection.

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Herpes Latency

The state where the herpes virus resides within the body in a dormant state, without causing symptoms.

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Herpes Triggers

Factors that can trigger a reactivation of the herpes virus, leading to a new outbreak.

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HSV-1 Antibodies

The presence of HSV-1 antibodies in the blood, indicating a past infection.

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HSV-2 Antibodies

The presence of HSV-2 antibodies in the blood, indicating a past infection.

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Oro-Labial Herpes

The most common type of herpes infection affecting the mouth and lips.

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What are keloids and hypertrophic scars?

Raised, tender, and erythematous lesions that remain permanently raised. They differ from typical scars by being more raised and firm.

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What is a keloid?

A type of scar that extends beyond the original wound borders.

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What is a hypertrophic scar?

A type of scar that remains confined within the original wound boundaries.

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What factors increase the risk of developing keloids and hypertrophic scars?

Inflammation, infection, foreign objects, and tension.

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What is the likely cause of keloids and hypertrophic scars?

Increased production of extracellular matrix components due to excessive transforming growth factor beta (TGF-β) activity.

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What are some treatment options for keloids and hypertrophic scars?

Massage therapy, intralesional steroid injections, surgery with steroid injections, and experimental topical therapies.

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What are striae distensae?

Pink-to-red-to-purple linear depressions on the skin that are typically asymptomatic but can mildly itch.

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What is the primary cause of striae distensae?

Rapid weight gain in a specific area.

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What is Erythema Migrans?

A skin rash that is a common symptom of Lyme disease. It appears as a red, expanding, ring-shaped area around the tick bite.

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What is Lyme Disease?

A bacterial infection transmitted through the bite of infected ticks.

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What is Ixodes?

A type of tick that transmits Lyme disease.

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How Long Must a Tick Be Attached to Spread Lyme Disease?

The time a tick must be attached to a person's skin for Lyme disease to be transmitted.

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What is Erythema Multiforme (EM)?

A skin condition that often presents as red, target-shaped lesions.

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What Is the Most Common Cause of Erythema Multiforme?

A common trigger for Erythema Multiforme (EM).

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How is Lyme Disease Treated?

The treatment for Lyme disease.

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How is Lyme Disease Diagnosed?

The methods used to confirm a diagnosis of Lyme disease.

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Genital Warts

A common sexually transmitted infection caused by the human papillomavirus (HPV), typically appearing as verrucous papules on the genitalia or genital area.

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HPV Types in Genital Warts

HPV types 6 and 11 are most commonly associated with genital warts.

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Appearance of Genital Warts

Genital warts can be found on the penis, perianal area, and vulva. They may appear slightly darker or lighter than the surrounding skin, with a rough, pebbly texture.

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Risk Factors for Anal Carcinoma

Individuals with suppressed immune systems, like those with HIV or organ transplants, have a higher risk of developing anal carcinoma associated with genital or perianal warts.

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HPV Persistence After Resolution

Most genital warts will resolve spontaneously, but the HPV DNA may still be present in the body, even if the lesions disappear.

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Lifelong Risk of Recurrence

Anyone who has had a genital wart is considered to be at lifelong risk for recurrence due to the potential for latent HPV infection.

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Genital Wart Treatment Categories

Treatments for genital warts can be broadly categorized into destructive therapies (e.g., freezing, burning) and immunity-based therapies (e.g., boosting the immune system).

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Genital Warts in Children

Genital warts in young children are not always a sign of sexual abuse but should be investigated by a healthcare professional.

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What is Tinea Versicolor?

A fungal infection characterized by hypopigmented or hyperpigmented macules, often seen on the chest, back, and shoulders.

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What causes Tinea Versicolor?

Pityrosporum ovale, a type of yeast, thrives on lipids (like sebum) found on the skin.

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Why does Tinea Versicolor cause hypopigmentation?

Dicarboxylic acids produced by the yeast inhibit melanin formation, leading to the hypopigmentation seen in Tinea Versicolor.

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How is Tinea Versicolor treated?

Ketoconazole shampoo, antifungal creams (like ketoconazole, econazole, or miconazole), and oral medications like ketoconazole or fluconazole are effective treatments for Tinea Versicolor.

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What causes 'crab lice'?

The crab louse (Phthirus pubis), known for its claw-shaped legs, is the cause of Pediculosis Pubis.

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Where is Pediculosis Pubis typically found?

Pediculosis Pubis, commonly known as 'crab lice', is often seen in sexually active individuals, particularly in the genital area.

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What is the main symptom of Pediculosis Pubis?

Severe itching in the genital region is a common symptom of Pediculosis Pubis.

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How is Pediculosis Pubis often diagnosed?

The lice are small and difficult to see, but the affected area often shows redness and scratching marks.

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Study Notes

Hyperhidrosis

  • Affects up to several percent of the population
  • Primarily affects palms, soles, and armpits; sometimes only one area
  • Two main patterns: emotional stress-induced (predominantly palms/soles) and continuous (predominantly armpits)
  • Palm/sole sweating controlled by the cerebral cortex, responding to stress (increased grip) and not to core body temperature
  • Armpit sweating controlled by both cortical and hypothalamic centers, reacting to both emotional stimuli and core body temperature
  • Emotional hyperhidrosis involves overactive cortical centers
  • Continuous axillary hyperhidrosis involves overactive hypothalamic centers
  • First-line treatment is aluminum chloride (blocks sweat duct)
  • If aluminum chloride is ineffective, dermatological referral for surgical techniques, anticholinergics, or electrical stimulation is needed
  • Anxiolytics or psychological interventions are helpful for anxiety-related hyperhidrosis
  • Can be associated with rare neurologic conditions, spinal cord injuries, and endocrine disorders

Keloids and Hypertrophic Scars

  • Common, particularly in African Americans for keloids
  • Both involve excessive scar tissue formation
  • Keloids extend beyond the initial wound border
  • Hypertrophic scars remain within the original wound border
  • Both are raised, tender, and erythematous initially; remain raised permanently
  • Associated with familial (genetic) components
  • Increased risk in certain body areas (earlobes and central chest)
  • Inflammation, infection, foreign bodies, and tension increase risk of formation

Striae Distensae (Stretch Marks)

  • Affects up to 25% of people during puberty and upwards of 75% during pregnancy
  • Appear as pink to red-purple linear depressions; fade over time
  • Can be itchy; usually asymptomatic
  • Common locations in males: thighs, lower back, upper back/shoulders
  • Common locations in females: breasts, thighs, buttocks
  • Abdomen is most common location in pregnant women
  • Can be related to certain medical conditions (Cushing's disease, steroid abuse)
  • Cannot be prevented entirely, but retinoids and lasers may help with appearance improvements.

Oral and Genital Herpes Simplex Virus (HSV)

  • HSV-1 antibodies found in 80-90% of the population
  • HSV-2 antibodies in 15-25% of the population
  • HSV-1 is more common in oral herpes
  • HSV-2 is more common in genital herpes
  • Symptoms include pain, burning, tingling before blisters; often follow by sores
  • Symptoms can be asymptomatic, particularly in genital herpes;
  • Infection usually occurs through direct skin-to-skin contact
  • Treated with oral or IV antiviral medications (acyclovir, valacyclovir)
  • Latency in the nerve tissue; stress, trauma, infections can reactivate the virus
  • Some infections, like eczema herpeticum, can spread widely in immunocompromised patients

Erythema Migrans

  • Cutaneous manifestation of Lyme disease
  • Presents as expanding red plaque; central area often clears
  • Usually asymptomatic
  • Typically appears 2-14 days after tick bite
  • Treated with doxycycline
  • Diagnosis confirmed with ELISA and Western blot tests

Erythema Multiforme (EM)

  • Self-limited disorder, rare in young children and adults older than 40
  • Often triggered by herpes simplex infections
  • Characterized by skin lesions; "target lesions:" red with pale, edematous center, red ring
  • Can involve areas like hands, forearms, chest, palms, legs, and oral mucosa

Genital Warts

  • Common sexually transmitted infection (STI)
  • Caused by HPV types 6 and 11
  • Appear as rough, "pebbly" papules; may be hypo- or hyper-pigmented
  • Can lead to cervical or anal cancer, especially in immune-compromised patients
  • Treated with topical insecticides (e.g., permethrin) or oral ivermectin; some resolve spontaneously

Plantar Warts

  • Common, painful warts occurring on the soles of the feet
  • Often located on the ball or heel
  • Characterized by skin line disruptions and black dots (capillary bleeding)
  • Treated with a multimodal approach including chemical/physical debridement of the surrounding keratin to allow penetration of the medication, salicylic acid solutions/pads, or other anti-HPV medications

Tinea Versicolor (TV)

  • Yeast (Pityrosporum ovale) overgrowth
  • Hypo- or hyperpigmented macules (patches)
  • Commonly located on upper chest, upper back, and shoulders
  • More common in the warmer months
  • Topical antifungals (ketoconazole shampoo, creams) or oral medications are typically used for treatment

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Description

Explore key clinical questions regarding Lyme disease and hyperhidrosis through this quiz. From symptoms to treatments, test your knowledge on these important medical conditions. Ideal for students and professionals in the medical field.

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