Case Files 33-34 Flashcards
What’s guttate psoriasis?
psoriasis variant often following strep infection
sudden eruption of small round or oval psoriatic lesions on trunk, face & prox limbs
what’s nummular dermatitis?
pruritic boggy or vesicular round lesions erupt on extrems, buttocks and shoulders. If they occur chronically, lichenification can occur
what’s pityraisis lichenoides chronica?
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
what’s pityriasis rosea?
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)
what causes pityriasis rosea, how long does it last? how do you tx it?
cause unkonwn, but likely viral
lesions last 2-12 wks, usu asymptomatic
Tx: bland emollient, antihistamines or topical corticosteroids if pruritus
what’s an import differential for pityriasis rosea?
secondary syphilis esp if sexually active adolescent & lesions on palms or soles
what helps you distinguish pityriais lichenoides chronica from pityriasis rosea?
lack of herald patch and chronicity of the lesions
what’s tinea corporis?
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
how do you treat tinea corporis?
topical azoles - Ketoconazole, clotrimazole or systemic antifungals - griseofulvin
what’s pityriasis alba?
hypopigmented macules w/ fine scale usu on face, neck, upper trunk and prox upper extrems
What’s Wiskott-Aldrich syndrome?
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
What’s brudzinski sign?
pt is supine, neck’s passively flexed resulting in involuntary knee and hip flexion. PE finding in meningitis
what’s encephalitis
brain parenchyma inflammation causing brain dysfxn
what’s kernig sign?
pt’s supine, legs are flexed at hip and knee at 90 degree resulting in pain w/ leg extension - consistent w/ meningitis
what’s meningitis
leptomeningeal inflammations, usu infectious
what are the MC causes of neonatal meningitis?
E. coli and GBS (S. agalactiae)
what are increased risks for neonatal meningitis?
low birth weight, preterm, mom w/ chorioamnionitis, prolonged ROM, traumatic delivery
how does most neonatal bacterial meningitis occur?
hematogenous spread
what are symptoms of neonatal menigntis?
thermal instability (usu hypothermic), poor feeding, emesis, seizures, irritable, apnea, bulging fontanelle, hyper or hypotonicity
what are the MC causes of bacterial meningitis in older kids?
Strep pneumoniae or Neisseria meningitidis (unvaccinated - H. influenzae type B)
Who’s at higher risk for bacterial meningitis in older kids?
kids w/ poorly fxning or absent spleen or w/ sickle cell b/c Staph pneumoniae is an encapsulated bacteria (MC in winter)
What are risk factors for bacterial meningitis in older kids?
Asplenic, sickle cell, sinusitis, otitis media, pneumonia, head trauma w/ CSF leak
what are classic symptoms of meningitis in older kids and adults?
mental status changes, N/V, lethargy, restlessness, ataxia, back pain, + kernig and brudzinski signs, CN palsies, seizures
If a pt has N. meningitidis meningitis what else might they have?
petechial or purpuric rash assoc w/ septicemia - gravely ill
How do you test for meningitis?
Lumbar puncture
what are contraindcations for lumbar puncture?
skin infection over planned puncture site, evidence or concern for increased ICP, critcally ill who can’t tolerate it
What’s included in a CSF analysis?
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
what are typical findings from LP in pt w/ bacterial menigntis?
elevated opening pressure, 100s to 1,000s of WBCs w/ PMN cell predominance, elevated protein, decreased glucose
what’s the MC tx for neonatal bacterial meningitis?
Ampicillin w/ 3rd generation cephalosporin or aminoglycoside to cover GBS, L. monocytogens and E.coli
How would you treat suspected pneumococcal meningitis?
3rd generation cephalosporin plus vancomycin (b/c of high penicillin resistance)
What are most N. meningitidis strains susceptible to?
penicillin or cephalosporins
What are acute meningitis complciations?
seizures, CN palsies, cerebral infarction, cerebral or cerebellar herniation, venous sinus thrombosis, subdural effusions, SIADH w/ hyponatremia, central diabetes insipus, hearing loss
what’s the MC long-term sequela w/ acute meningitis, esp w/ pneumococcus?
hearing loss
