Case Files 33-34

Question 1

What’s guttate psoriasis?

Answer 1

psoriasis variant often following strep infection

sudden eruption of small round or oval psoriatic lesions on trunk, face & prox limbs

Question 2

what’s nummular dermatitis?

Answer 2

pruritic boggy or vesicular round lesions erupt on extrems, buttocks and shoulders. If they occur chronically, lichenification can occur

Question 3

what’s pityraisis lichenoides chronica?

Answer 3

multi, small (3-5 mm), red-brown papules covered w/ gray scale on trunk and extremities. They can become vesciular, hemorrhagic, crusted, or superinfected. By 2-6 wks become flat and hyper or hypopigmented

Question 4

what’s pityriasis rosea?

Answer 4

benign childhood skin eruption of pink oval/round lesions <1cm diameter w/ raised edges & scale on surface. Hearld patch (single lesion 1-10 cm) often noted 5-10 days before generalized eruption along cleavage planes (Christmas tree pattern)

Question 5

what causes pityriasis rosea, how long does it last? how do you tx it?

Answer 5

cause unkonwn, but likely viral
lesions last 2-12 wks, usu asymptomatic
Tx: bland emollient, antihistamines or topical corticosteroids if pruritus

Question 6

what’s an import differential for pityriasis rosea?

Answer 6

secondary syphilis esp if sexually active adolescent & lesions on palms or soles

Question 7

what helps you distinguish pityriais lichenoides chronica from pityriasis rosea?

Answer 7

lack of herald patch and chronicity of the lesions

Question 8

what’s tinea corporis?

Answer 8

ringworm
superficial cutaneous fungal infection caused y Microsporum canis, trichophytom tonsuran, rubrum or metagrophytes.
erythematous papule that expands to curcular, scaly, erythematous lesion w/ raised borders. central clearing and pruritus is possible

Question 9

how do you treat tinea corporis?

Answer 9

topical azoles - Ketoconazole, clotrimazole or systemic antifungals - griseofulvin

Question 10

what’s pityriasis alba?

Answer 10

hypopigmented macules w/ fine scale usu on face, neck, upper trunk and prox upper extrems

Question 11

What’s Wiskott-Aldrich syndrome?

Answer 11

rare X-linked disorder of recurrent bacterial infections, bleeding secondary to thrombocytopenia w/ platelet dysfxn, chronic dermatitis. can lead to autoimmune hemolytic anema. Need BM transplant or die by 3 yo

Question 12

What’s brudzinski sign?

Answer 12

pt is supine, neck’s passively flexed resulting in involuntary knee and hip flexion. PE finding in meningitis

Question 13

what’s encephalitis

Answer 13

brain parenchyma inflammation causing brain dysfxn

Question 14

what’s kernig sign?

Answer 14

pt’s supine, legs are flexed at hip and knee at 90 degree resulting in pain w/ leg extension - consistent w/ meningitis

Question 15

what’s meningitis

Answer 15

leptomeningeal inflammations, usu infectious

Question 16

what are the MC causes of neonatal meningitis?

Answer 16

E. coli and GBS (S. agalactiae)

Question 17

what are increased risks for neonatal meningitis?

Answer 17

low birth weight, preterm, mom w/ chorioamnionitis, prolonged ROM, traumatic delivery

Question 18

how does most neonatal bacterial meningitis occur?

Answer 18

hematogenous spread

Question 19

what are symptoms of neonatal menigntis?

Answer 19

thermal instability (usu hypothermic), poor feeding, emesis, seizures, irritable, apnea, bulging fontanelle, hyper or hypotonicity

Question 20

what are the MC causes of bacterial meningitis in older kids?

Answer 20

Strep pneumoniae or Neisseria meningitidis (unvaccinated - H. influenzae type B)

Question 21

Who’s at higher risk for bacterial meningitis in older kids?

Answer 21

kids w/ poorly fxning or absent spleen or w/ sickle cell b/c Staph pneumoniae is an encapsulated bacteria (MC in winter)

Question 22

What are risk factors for bacterial meningitis in older kids?

Answer 22

Asplenic, sickle cell, sinusitis, otitis media, pneumonia, head trauma w/ CSF leak

Question 23

what are classic symptoms of meningitis in older kids and adults?

Answer 23

mental status changes, N/V, lethargy, restlessness, ataxia, back pain, + kernig and brudzinski signs, CN palsies, seizures

Question 24

If a pt has N. meningitidis meningitis what else might they have?

Answer 24

petechial or purpuric rash assoc w/ septicemia - gravely ill

Question 25

How do you test for meningitis?

Answer 25

Lumbar puncture

Question 26

what are contraindcations for lumbar puncture?

Answer 26

skin infection over planned puncture site, evidence or concern for increased ICP, critcally ill who can’t tolerate it

Question 27

What’s included in a CSF analysis?

Answer 27

gram stain and culture, WBC and RBC counts, protein and glucose analysis. Can do bacterial antigen screens even if already receiving Abx b/c antigens may persist for several days even if culture is negative

Question 28

what are typical findings from LP in pt w/ bacterial menigntis?

Answer 28

elevated opening pressure, 100s to 1,000s of WBCs w/ PMN cell predominance, elevated protein, decreased glucose

Question 29

what’s the MC tx for neonatal bacterial meningitis?

Answer 29

Ampicillin w/ 3rd generation cephalosporin or aminoglycoside to cover GBS, L. monocytogens and E.coli

Question 30

How would you treat suspected pneumococcal meningitis?

Answer 30

3rd generation cephalosporin plus vancomycin (b/c of high penicillin resistance)

Question 31

What are most N. meningitidis strains susceptible to?

Answer 31

penicillin or cephalosporins

Question 32

What are acute meningitis complciations?

Answer 32

seizures, CN palsies, cerebral infarction, cerebral or cerebellar herniation, venous sinus thrombosis, subdural effusions, SIADH w/ hyponatremia, central diabetes insipus, hearing loss

Question 33

what’s the MC long-term sequela w/ acute meningitis, esp w/ pneumococcus?

Answer 33

hearing loss