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Pediatric Emergency Medicine > Derm > Flashcards

Derm Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

1) What is the presentation of erythema infectiosum?
2) What is the infectious organism?
3) What labwork should you consider getting?

A

1) “slapped cheek disease”-erythematous cheeks–>reticular rash over extensor surfaces–>spreads to trunk
2) Parvovirus B19-viral so self resolves, supportive care
3) CBC-Can cause acute anemia, especially in those with RBC fragility/dyscrasias

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2
Q
  • What is the presentation of erythema multiforme?
  • How should it be treated?
  • What complication should you watch out for?
A
  • Targetoid rash with a necrotic center ussually following a viral prodrome
  • This is an immune mediated rash that can be caused by drugs or post viral so treat the underlying cause
  • If there is mucous membrane involvement rule out steven johnson syndrome
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3
Q

What is the presentation and management of pityriasis rosea?

A
  • Initially there is a “herald patch” over the trunk, 1-2 weeks later there is a Christmas tree pattern of “orzo pasta” over back
  • supportive care, self resolves in 6 weeks
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4
Q

What are the presentation, complications, and management of chicken pox?

A
  • Vesicular rash with erythematous base starting on face and truck, spreads all over with multiple stages of healing
  • Complications include: cerebelar ataxia, keratoconjunctivitis (perform an eye exam), strokes, vasculitis
  • Supportive care for most children, consider acyclovir in young children or those with comorbidities.
  • Advise to stay away from pregnancy women, those with immunocompromised
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5
Q

What is the presentation of and management of scarlet fever?

A
  • s/p GAS infection so sore throat, fever, sandpaper-like goosebump rash and red lines in skin creases
  • Tx the GAS infxn by giving penicillin, if unclear diagnosis could do strep swab
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6
Q

What is the presentation of and management of phytophotodermatitis?

A
  • Child abuse mimic rash-erythema/scalding of areas in contact with both citrus fruits and sunlight
  • Give tylenol, steroids and advise sunblock in the future
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7
Q

What is the presentation of and management of impetigo?

A
  • A proceeding staph/strep infection–>honey crusting scabing of the hands and face with localized blistering
  • give topical mupiricin vs po keflex
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8
Q

What is the presentation of and management of staph scalded skin syndrome?

A
  • Presents w/sunburnt appearance of face and spreads to trunk with positive Nikolsky sign
  • Similar to a burn-Admit for IV fluids, pain control, Abx
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9
Q

What is the presentation, complications and management of herpangina?

A
  • hand foot mouth disease
  • Complications include pericarditis, myocarditis, pleuritis, and aseptic meningitis
  • Give return precautions, advise for pain control and hydration
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10
Q

Give some tricks to complete the neurovascular assessment in an injured extremity of a noncompliant kid.

A

1) place the extremity in water-denervated skin will not shrivel or sweat
2) run the plastic part of a ballpoint pen over the skin, should be able to run smoothly if patient can sweat

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11
Q

What type of sutures should you consider using on the hands, fingers or scalp?

A

5.0 chromic gut vs vicryl rapide

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12
Q
  • What type of sutures should you consider using on the face?
  • When should you have the family get the sutures removed?
A
  • 6.0 fast absorbing gut vs vicryl rapide

- remove in 5 days

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13
Q

What are the clinical features of henoch schonlein purpura?

A

1) palpable purpura-lower extremities and back
2) arthralgia/arthritis-associated w/edema and erythema of joints
3) abdominal pain
4) renal disease

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14
Q

How should Henoch Schonlein purpura be managed?

A
  • Pain control with NSAIDs
  • obtain a urine dip and get renal function testing and a renal consult if positive for blood
  • rule out intussusception with an abdominal ultrasound
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15
Q

What are the diagnostic criteria of Kawasaki disease?

A 
CRASH+Burn
Conjunctivitis-limbic sparing
Rash-could look like anything
Adenopathy-Cervical, can be unilateral
Strawberry tongue-or other oral mucosal changes
Hands and feet swelling
>/= 5 days of fever
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16
Q

What labwork should be obtained to rule out atypical Kawasaki disease and what would you expect on labs??

A
  • CBC, ESR, CRP, BMP, Hepatic, UA (clean catch>straight cath)
  • Increased: WBC, ESR, CRP, Plts, ALT
  • Decreased: albumin, Na, Hgb
  • sterile pyuria-WBCs w/out bacteria on UA, can mimic UTI
17
Q

What are complications of Kawasaki Disease?

A
  • Coronary artery aneurysms
  • gallbladder hydrops
  • myocarditis
  • pericarditis
18
Q

How should Kawasaki disease be managed?

A
  • Aspirin-start high dose
  • IVIG
  • Cards consult
19
Q
  • What is hydradenitis suppurativa and how does it present?
  • How should it be managed?
  • What comorbid conditions should you consider when it is encountered?
A
  • Chronic, Recurrent Inflammatory disorder of the hair follicles and apocrine glands in intertriginous areas. Typically an adolescent (F>M) with recurrent boils in the axilla or inguinal creases
  • Do no harm-inclination to drain abscesses is wrong here as this will lead to further inflammation and more fistulous tracks. Treat based on symptoms from topical clinda to oral doxy. Outpatient derm referral
  • Common comorbidities include obesity, diabetes, premature adrenarche, IBD
20
Q
  • When can an abscess be simply I+Dd w/out antibiotics?
  • When should you add antibiotics?
  • When should you culture an abscess?
A
  • If it is 5cm or less, not rapidly expanding, and the child is well-appearing: I+D alone
  • Use Antibiotics in addition to I+D for:
    (1) Severe or extensive disease (involving multiple sites, rapidly progressing, or significant cellulitis)
    (2) Signs and symptoms of systemic illness
    (3) Associated with co-morbidities or immunosuppression
    (4) Abscess in area that is difficult to drain adequately (hand, face, genitalia)
    (5) Lack of response to prior I+D alone
  • Culture the abscess if you give antibiotics to ensure you are properly treating
21
Q
  • What are the general steps of performing a loop abscess drainage?
  • What post care should you advise the family?
A
  • Steps (watch a video so it makes sense):
    1) Incise lateral edge of abscess cavity with small 4-5mm incision.
    2) Gently explore abscess cavity and break up loculations w/curved hemostat or needle driver
    3) Find edge of abscess cavity.
    4) 2nd incision in this region
    5) Irrigate and get the pus out
    6) Pass vessel loop, sterile rubber band, or Penrose Drain though two incisions.
    7) Loosely tie the ends together so that it is freely mobile
  • Post care-Patient should keep the area clean at home and they can shower and cover with gauze. Advice them to turn the loop 1-2x/day. Remove in 7 days after drainage has stopped and cellulitis has improved

Pediatric Emergency Medicine (18 decks)

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