MRCME Febrile Rash

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Differential Diagnosis For Rash and Fever: 

Differential Diagnosis For Rash and Fever Gen Med 1 A “THE A TEAM”

How do you describe this rash?: 

How do you describe this rash? Multiple erythematous macules and/or papules, a few millimeters to 1 cm in size coalescing together. Symmetric distribution on trunk, extremities, and Intertriginous area.

Derm Lingo: 

Derm Lingo Macule: flat, nonpalpable circumscribed area of change in the skin color, may be any size. Papule: small solid elevation of skin generally < 5 mm in diameter. Plaque: palpable, plateau-like elevation of skin > 5mm in diameter. Nodule: palpable, solid, round, or ellipsoidal lesion > 5 mm diameter. Vesicle (blister): circumscribed, elevated lesion that is < 5 mm in diameter containing serous (clear) fluid. Bulla: A vesicle with a diameter > 5 mm. Pustule: superficial, elevated lesion that contains pus. Cyst: an epithelial lined cavity containing liquid or semisolid material. Wheal: transitory, compressible papule or plaque of dermal edema

Describing a Rash: 

Describing a Rash Color Margination Shape Palpation Number Arrangement Confluence Distribution

The Presence of Fever & Rash should raise the following questions?: 

The Presence of Fever & Rash should raise the following questions? Site of onset, rate & direction of spread. Distribution, configuration and arrangement of the lesion? Is there erythema, hypo, or hyperpigmentation? Are there secondary characteristics such as scale? Is pruritus present? Is the patient taking any meds (prescription, OTC, herbal) Travel History? Immune Status?

Differential Dx for maculopapular Rash and Fever: 

Differential Dx for maculopapular Rash and Fever Viral Exanthems: rubeola, rubella, erythema infectiosum (Parvo), roseola (HHV-6), Coxssackievirus, echovirus, EBV, adenovirus, dengue, West Nile, CMV, Bacterial Infections: Strep pyogenes (Scarlet Fever), Staph aureus (TSS), Meningococcemia, RMSF Other Infections: Sec Syphilis, Lyme Dx Kawasaki’s Dx Drug Eruption: (penicillin, tetracyclines, sulfonamides, dilantin, barbituates, phenylbutazone, NSAIDS, salicylates) Erythema Multiforme SJS or TEN: Usually drug induced Rheum: SLE, Reiter’s Syndrome

How do you describe this rash?: 

How do you describe this rash? Multiple tense vesicles and bullae around the axilla.

Differential Diagnosis for Bullous Rash: 

Differential Diagnosis for Bullous Rash Viral (HSV, Coxsackie, Varicella & Herpes Zoster) Bacterial (Staphylococcal) – Bullous Impetigo Drug Rxn Allergic Contact Dermatitis Insect Bite Porphyria Cutanea Tarda Autoimmune blistering diseases of the skin: Intraepidermal bullous diseases: Pemphigus vulgaris, Pemphigus foliaceus, Paraneoplastic pemphigus Subepidermal bullous diseases: Bullous Pemphigoid, Herpes Gestationis, Cicatricial Pemphigoid, Epidermolysis Bullosa Acquisita, Linear IgA Bullous Dermatosis

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