Dermatologic Differential of Common Skin Lesions and Rashes
Name Cause Sign/symptoms Diagnostics Treatment Concerns Rocky Mountain Spotted Fever
Tick bite Rickettsia rickettsii
Fever, chills, severe headache, n/v, photophobia, myalgia, conjunctival injection, arthralgia; 2-5 days after onset – rash (petechiae) starts on hands/feet to trunk (palmar rash)
Antibody titers to rickettsia Punch biopsy CBC, LFT, CSF
Doxycycline 100mg BID for 7-14 days – can be fatal if not started on treatment within 8 days. Remove tick by grasping closest to skin and apply steady upward pressure
Can be fatal (3- 9%) Highest in southeast ern/sout h central regions of US Most common Apr – Sept
Erythema Migrans (Lyme disease) Meningococ cemia
Varicella / Zoster
Malignant Melanoma
Basal Cell Carcinoma
Actinic Keratosis
Erythema Multiforme (Stevens- Johnson syndrome)
Differential Diagnoses of Eye Emergencies
Name Cause Signs/Sym ptoms
Diagnostics Treatments Concerns
Corneal Abrasion
Trauma, foreign body, incorrect use of contact lenses
Acute onset severe eye pain with tearing. Reports feeling of foreign body sensation
Eye exam with Fluorescein dye
Flush eye with sterile normal saline. Evert eyelid to look for foreign body. Topical antibiotic trimethoprim- polymyxin B (Polytrim),Ciproflox acin (Ciloxan), Ofloxacin (Ocuflox) to affected eye 3-5 days. Do not patch eye.
Contact Lens- Related Keratitis – acute onset red eye, blurred vision, watery eyes, photoph obia, foreign body sensation
Hordeolum (Stye)
Chalazion Pinguecula Pterygium Subconjunctiv al Hemorrhage
Primary Open-Angle Glaucoma
Macular Degeneration
Differential Diagnoses of Common Headaches
Name Sign/symptom s
Aggravating factors
Acute treatment
Prophylaxis
Migraine Without Aura
Throbbing pain behind one eye, photophobia, N/V phonophobia, last 4-72 hr.
Red wine, MSG, aspartame, menstruation, stress
Ice pack on forehead, rest in dark quiet room Triptans, Tigan suppositorie
TCAs Episodic migraine (<14 days per month) Beta-blockers
Migraine With Aura
Trigeminal Neuralgia (CN V)
Cluster Muscle Tension
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