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Peds Exam 2 > Lecture 11: Dermatology & ID > Flashcards

Lecture 11: Dermatology & ID Flashcards

1
Q

What is milia?

Tx needed?

A

keratin filled papules w/NO erythema (usu face)

No - benign/self-limiting

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2
Q

Mother brings newborn in concerned that the child’s pores looked clogged. Most likely Dx

What is this d/o related to & result?
Regression?

A

Sebaceous gland hyperplasia

related to maternal androgens –> incr # sebaceous cells
- regression when maternal hormones decline

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3
Q

When does neonatal acne appear/resolve?

Scarring Y or N?

Although self limiting - what is possible Tx for acne?

A

appears ~2wks and resolves after maternal hormones declines (3-4 mo)
- Note: also related to maternal androgens like sebaceous hyperplasia

NO scarring

Tx w/soaps or benzoyl peroxide (drying)

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4
Q

Infant comes in w/yellow-greasy scales on scalp, most likely Dx? name of this sign?

A

Dx = Seborrheic dermatitis

“Cradle Cap”

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5
Q

Cause of seborrheic dermatitis

Although Tx not necessary, what are 2 Tx options for this?

A

Malassezia furfur

Tx = Ketoconazole cream/shampoo or Topical Hydrocortisone cream

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6
Q

Baby comes in w/odd, widespread coloring of body that is transient. Most likely Dx?

What is the cause of this color change?

A

Harlequin Color Change (usu benign)

immature autonomic NS –> transient vasodilation

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7
Q

Baby presents w/pink-purple marbly/lacy pattern that is symmetric on extremities after baby left out on changing table for while. Dx?

What is the umbrella term for the pattern of rash in this d/o?

A

Mottling (cutis marmorata)

Livedo reticularis = umbrella term for pink-purple marbly/lacy pattern

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8
Q

Presentation of baby w/congential mottling (cutis marmorata telangiectasia congenita)

A

asymmetric size of one limb to the other

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9
Q 
Normally mottling resolves w/warming (rash = response to cold trigger)
If mottling (cutis marmorata) is unresolved with warming what does that indicate?
A

shock or poor CO

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10
Q

Presentation of erythema toxicum?

What is seen on pathology, which makes cause likely d/t?

A

small raised bumps w/surrounding erythema all over

Pathology = eosinophils
- cause could be Hypersensitivity (BUT NOT AN ALLERGY)

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11
Q

baby presents w/skin condition: vesicles w/cloudy fluid that crusted over and are now hyperpigmented macules. Pathology reveals neutrophils. Dx?

A

Pustular Melanosis

- no Tx

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12
Q

Key difference b/t presentation of allergic contact dermatitis and candidal diaper dermatitis?

A

Allergic contact – CREASES SPARED

candidal – affects creases/folds

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13
Q

How does exposure to irritant cause inflam in allergic contact dermatitis?

Tx for diaper area, face or severe?

A

irritant recruits pre-sensitized T cells –> inflam

Tx

  • diaper area = Emollients (zinc oxide cream, petrolatum)
  • face or severe = Hydrocortisone
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14
Q

Neonate comes in w/angry, beefy red lesions affecting folds and creases. Dx?

Name of these types of lesions?

Tx?

A

Candidal Diaper dermatitis
- a/w satellite lesions

Tx = topical Nystatin, keep dry

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15
Q

Pt presents w/benign blue/black patches on sacrum, back and extremities that fades after few years. Dx?

A

Slate gray patch (Mongolian spots)

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16
Q

Difference b/t Mongolian spot and bruise?

A

Mongolian spots - color doesnt change w/time like bruise

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17
Q

What skin condition is characterized by brown hyperpigmented, irreg shaped macules that are a/w genetic condition?

> 6 spots and more than 5 mm = concern for?

A

Cafe Au Lait spots

> 6 spots and > 5 mm –> Neurofibromatosis

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18
Q

What is a hemangioma d/t?

What 3 things make a hemangioma concerning?

A

dysregulation of endothelial stem cells

  1. area where vision, breathing, feeding affected
  2. very large –> ulceration & prone to inf
  3. midline on sacrum + dimple/tuft of hair –> occult spinal dysraohism/bifida
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19
Q

What is a port wine stain?

if affects what areas –> concern for what

A

Blanchable capillary malformation

affects upper and lower eyelids (V1 & 2 of trigeminal nerve) –> concern for Sturge-Weber Syndrome

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20
Q

Pt presents w/large ( > 6 cm) tan/black, irreg shaped lesion that also has hair w/in. Dx?

Why should you refer/be concerned?

A

Congenital Melanocytic Nevus

Concern b/c large –> risk of melanoma

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21
Q

9 Viral Diseases that cause rash

Vaccines for which 4?

A
  1. Measles (Rubeola)
  2. Mumps
  3. Rubella (+ congenital)
  4. Erythema Infectiosum (5th disease)
  5. Roseola Infantum (6th disease)
  6. Eczema Herpeticum
  7. Varicella-Zoster
  8. Herpes Zoster
  9. Molluscum Contagiosum

Vaccines = MMRV

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22
Q

How long are kids contagious for w/Measles (rubeola)

A

4 days before and after the rash

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23
Q

What is pathognomonic for Measles in the prodrome period?

What else is seen during the prodrome period (3)?

A

Koplik’s spots

Cough, Coryza, Conjunctivitis

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24
Q

Appearance of Koplik’s spots in Measles? where are they typically found?

A

Koplik’s spots

  • grey/blue/white bumps on erythematous base
  • in buccal + labia mucosa
25
Q

Pattern for the classic exanthem in Measles

A

Rash spreading from the forehead down

- blanches then coalesces/darkens

26
Q

You suspect a child has measles, what 3 tests can you do to confirm your suspicion?

What other precautions should be taken?

A
  1. RT-PCR
  2. IgM (active dz)
  3. IgG (acute or recovery stage)

put in isolation room, call health dept

27
Q

worst complications of Measles? what type of dz is it?
when does it occur?

Others:

  1. PNA
  2. diarrhea
  3. encephalitis
A

SSPE (subacute sclerosing panencephalitis)

  • progressive CNS dz
  • occurs 7-10 yrs after Measles
28
Q

Tx for kids w/Measles under age 2

- what is the benefit of this treatment

A

Vitamin A –> decr mortality

29
Q

Classic presentation that occurs 48hrs that is a/w Mumps

A

Parotitis - swollen parotid gland (neck/face)

“Bump’s b/c of Mumps”

30
Q

Child presents w/swollen neck and blurred angle of the jaw. What labs could be ordered/what seen to confirm the Dx (although not necessary - clinical dx)?

A

amylase (elevated)
lymphopenia

Dx = Mumps

31
Q

Possible 5 complications that can occur w/Mumps?

A
  1. SHL
  2. Encephalitis
  3. Aeseptic Menigitis
    4/5. Orchits or oophoritis
32
Q

Tx for mumps:

What type of precautions? How long to isolate at home?

A
  • droplet precautions

- isolate for 5 days after onset of Sxs

33
Q

A child is brought in by his pregnant mother. He has had 3 days of low grade fever and LAD w/onset of a faint pink maculopapular rash that spread from the head down. What should you be concerned about?

A

Concerned about the pregnant mother

- she cant get the live virus Rubella vaccine to protect her against congenital Rubella syndrome

34
Q

When is worse to acquire a Congenital Rubella Syndrome? Classic Triad in this time period?

What type of infection is Congenital Rubella Syndrome?

A

in the 1st trimester
- Cataracts, Cardiac defects, Deafness

TORCH infxn

35
Q

A baby is born w/HSM and jaundice, microcephaly and has “blueberry muffin top lesions”. What is the dx?

What are “blueberry muffin top lesions” and what are they d/t?

What other TORCH infxn could cause these type of lesions?

A

Congenital Rubella Syndrome

“blueberry muffin top lesions” = purpura from low plts
- DDX = CMV

36
Q

Girl w/SCD comes in w/ lacy rash on extensor surfaces of arms, trunk and neck. She had bright red cheeks a few days ago. Labs show low retics and anemia. What is the Dx? Cause?

What complication are you concerned about d/t low retics and anemia? Why? Tx?

A 
Dx = 5th Dz (Erythema Infectiosum)
Cause = Parvovirus B19

Concern –> aplastic anemia b/c she has hemolytic anemia
- she may need a transfusion

37
Q

What does Erythema Infectiosum (5th Dz) cause if an intrauterine infection occurs?

A

Hydrops Fetalis

38
Q

Cause of Roseola Infantum? Other name for this d/o?

A

Cause = Human Herpesvirus-6 (HHV-6)

Roseola Infantum = 6th Dz

39
Q

Child presents w/ blanching, pink, maculopapular rash that started on neck/trunk then spread to face/extremities. A few days prior she had extremely high fever lasting 4 days and experienced one generalized seizure. Dx?

When do you become concerned about seizures?

A

Roseola Infantum/6th Dz

Concern about seizures if focal and more than 1 in 24hrs

40
Q

What types of pts does eczema herpeticum usu occur in?

Cause?

A

kids w/atopic dermatitis or immunocompromised

Cause = HSV

41
Q

Child presents w/ 1 day fever and “punched out” lesions (pustular/vesicular) that are very painful. What is the best Tx for her based on Dx?

What 2 signs indicate a bacterial superinfxn?

A 
Tx = Acyclovir + anti-Staph ABX (+/- IVFs)
Dx = Ezcema Herpeticum (caused by HSV)

swelling, erythema –> bacterial superinfxn

42
Q

How to Dx Varicella Zoster?

Tx for kids > 12 or immunocompromised?
Med for supportive care?
Who should avoid contact w/these pts?

A

Clinically or scraping a vesicle

Tx

  • cyclovirs
  • Non-ASA antipyretics

any pregnant should avoid contact

43
Q

Child w/cancer presents w/painful rash in single dermatome that originally tingled. What is Dx?

why does she need Tx, what are 2 other reasons to Tx? what is Tx?

A

Dx = Herpes Zoster (Shingles)

Tx needed b/c she is immunocompromised

  • also tx if: > 12 or trigeminal area affected
  • Acyclovir, Topical Antipruritics, PO analgesics
44
Q

Child presents w/flesh-colored umbilicated, fluid filled pustules that all appear all over their body except palms and soles. pt denies pruritus.

What is Dx?
Tx needed?

A

Dx = Molluscum Contagiosum

Tx not needed
- options: cryotherapy; curettage or Cantharidin (removal)

45
Q

2 y/o girl presents w/fever, generalized erythema w/flacid bullae in skin folds but no mucous membranes are involved. Some bullae have ruptured and have blistered over.

Best Tx for her?
(Dx?)

A

Tx = Admit –> ABX
- Naficillin, Clinda, Vanco

Dx = Scalded Skin Syndrome

46
Q

3 y/o boy presents w/rapid onset of fever, HA, vomiting and intense leg pain. He also has non-blanching purpuric rash that is seen on extremities/trunk and positive Kernig’s sign.

What are you concerned he could progress to?
What is best management for this pt?
(dx?)

A

Progress quickly to AMS, shock, DIC

Tx = IV Ceftriaxone x 7 days
- dont wait more than 30 min to give to get CSF culture

Dx = Neisseria Meningiditis

47
Q

Cause of Lyme dz? How spread?

A

Borrellia burgdorferi (spirochete)

spread by tic bite

48
Q

Features seen in each phase of presentation for Lyme Dz

  1. Early localized
  2. Early Disseminated
  3. Late
A
  1. Early localized –> erythema nigrans (target lesion)
  2. Early Disseminated –> multiple erythema nigrans +
    cardiac, neuro or non-spp Sxs
  3. Late - arthritis in large joint
49
Q

Tx for Lyme Dz: indications for

  1. Doxycycline
  2. Amoxicillin
  3. IV Ceftriaxone
A
  1. Doxycycline
    - early localized and > 8 y/o
    - early dissem: facial nerve palsy, 1st degree AV block
    - late dz + NO neuro Dz
  2. Amoxicillin
    - early localized and < 8 y/o
    - early dissem (same as Doxy)
  3. IV Ceftriaxone
    - worse early dissem: meningitis, 2nd/3rd degree block
    - Late Dz + Neuro Sx
50
Q

When does tissue damage occur in hyperthermia from fever

A

not until sustained temp b/t 41-42 C

51
Q

describe typical fever presentation by age group:

  1. Neonates
  2. Older infants/young kids
  3. older kids/adolescents
A
  1. Neonates –> +/- febrile response –> may be HYPOthermic
  2. Older infants/young kids –> +/- exag febrile response
  3. older kids/adolescents –> unlikely to have high fever
52
Q

3 General Tx options for fever (regardless of age)

A
  1. Acetaminophen
  2. Ibuprofen
  3. Alternating/combining 1 and 2
53
Q

General Tx options for fever:

  1. Acetaminophen: what is risk?
  2. Ibuprofen: what age group must it be used in?
  3. Alternating/combining 1 and 2: what is benefit?
A
  1. Acetaminophen–> risk of hepatotoxicity w/chronic use and OD
  2. Ibuprofen–> must be < 6 mo –> risk of nephrotoxicity w/dehydration
  3. Alternating/combining 1 and 2 –> incr efficacy in lower temp
54
Q

in kids < 3 mo which age group is at highest risk for IBI (invasive bacterial infxn)–> bacteremia, menigitis?

Tx for infants 28 days - 3 mo old?

A

infants < 28 days old

28 days - 3 mo old –> IM/IV Ceftriaxone or observation

55
Q

What criteria must be met for a child w/ a fever to be treated in the outpatient setting?

A
  1. child 28 days - 3 mo of age
  2. must be low risk criteria
  3. reliable f/u in 24 hrs
56
Q

Workup for _______ and ______

  1. Admit
  2. Workup
    - cultures: blood, urine, CSF
    - resp Sxs –> XR
    - diarrhea –> stool study
    - consider HSV if febrile + < 4 wks
  3. broad spectrum IV `ABXs
A

Workup for infants < 3 mo + appear ill and ALL infants < 28 days

57
Q

Definition of Fever of Unknown Origin (FUO)

How to manage FUO (2 things)?

A

Fever > 14 days + NO identified cause

Tx

  • AVOID ABXs
  • antipyretics + fluids
58
Q

What are the 3 MC causes of FUO? What is unique about their presentation?

A
  1. sinusitis
  2. UTI
  3. septic arthritis
  • uncommon/prolonged presentations of these illnesses

Peds Exam 2 (9 decks)

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