Miscellaneous Flashcards
Dermatology, Immunizations, Rheumatology
Features of this genetic condition include:
- micrognathia, abnormal external ears, clenched hands with overlapping fingers, increased muscle tone, low birth weight, single umbilical artery, short palpebral fissures, nail hypoplasia, and congenital heart defects (ventricular septal defect, atrial septal defect, and patent ductus arteriosus)
Trisomy 18
sloping forehead with holoprosencephaly, microphthalmia, cleft lip or palate, and polydactyly
Trisomy 13
Hemangioma involution
50% by 5 years
70% by 7 years
90% by 9 years
GLUT-1 positive
Hemangiomas
- Tufted Angiomas
- Thrombocytopenia
- Consumptive Coagulopathy
- Microangiopathic Hemolytic Anemia
Kasabach-Meritt (KHE, Tufted Angioma)
- Multiple hemangiomas of skin
- GI, Pulmonary, CNS, Liver Angiomas
Neonatal Hemangiomatosis
- Posterior fossa CNS abnormalities
- Hemangioma in V1 facial distribution
- Arterial anomalies –> seizures/stroke
- Cardiac defects
- Eye abnormalities (microphthalmia)
- Sternal clefting
PHACES Syndrome
- 90% F
- Ulceration of softe tissue
- Port Wine Stain in V1
- Hypertrophic soft tissue
- Glaucoma
- Meningeal Angioma
SWS
Lumbosacral hemangiomas
Tethered cord, intraspinal lipomas
Liver hemangiomas
HM, CHF, anemia and thrombocytopenia
Hypothyroidism
- Most common vascular birthmark
- On face and nape of neck, symmetrical about midline
- Present at birth
- Facial lesions usually resolve within one year
- Nuchal lesions persist in 50%
Salmon Patch
- Present at birth
- Grows with the child, darkens with age, becomes cobblestoned with soft tissue hypertrophy
Port Wine Stains (Nevus flammeus)
Rx: Pulse Dye Laser
- PWS
- Limb hypertrophy
- Venous and lymphatic malformations
- GI and bladder angiomas
Klippel Trenaunay
- Acquired vascular lesion
- Common on extremities, face
- Red papule that bleeds easily
- Need to remove
Pyogenic Granuloma (Lobular Capillary Hemangioma)
- Benign melanocytic lesion
- Dome-shaped, red to yellow to brown color
Spitz Nevus
- Very low risk of malignancy, but a malignant melanoma can mimic a spitz nevus
- Not present at birth, appears at 24 hours of age
- Papule or pustule with urticarial base
- Lasts 2-3 weeks
- See eosinophils if examine content of vesicle
Erythema Toxicum
- Presents with 2-3mm vesicles
- Vesicles rupture within hours, leaving a collaret of scale, followed by a hyperpigmented macule that lasts for months
- More common in African Americans
- Neutrophils without bacteria seen inside vesicle
Transient Neonatal Pustular Melanosis
Normal mottled response to cold
Cutis Marmorata
- Developmental disorder of capillaries and veins
- Often localized to one extremity, coarser texture
- Associated with glaucoma, cleft lip, mental retardation, syndactyly, hypothyroidism and dystrophic teeth
Cutis Marmorata Telangiectatica Congenita
- Indurated, non-tender plaque with patchy erythema appearing in the first few weeks of life
- Probably 2/2 trauma
- Resolves spontaneously
- May have associated hypercalcemia, leading to irritability, constipation, FTT, seizures
Subcutaneous Fat Necrosis
- Onset at 2-4 weeks of age, resolves by 3 months
- Papules and pustules without comedomes
- No treatment needed
- Some cases of “acne” are actually a folliculitis caused by Pityrosporum
Neonatal Acne
Acne that has a later onset or is prolonged, may be severe and require evaluation of androgens, Infantile acne
Dermatitis on interdigital/arch of foot
Tinea pedis
Dermatitis on weight-bearing surface of foot
Juvenile Plantar Dermatosis
Dermatitis on dorsum of foot
Contact dermatitis
Why should you not use oral ketoconazole?
Risk of fatal hepatitis
1st line treatment for onychomycosis
Itraconazole or Terbinifine x 4-6 months
- Adolescents
- Warm, humid weather
- Confluent macules of varying color with mild scale, upper body and occasionally on face
- KOH = spaghetti and meatballs
Tinea versicolor
- Treat with topical selenium or zinc shampoos
- Oral ketoconazole, itraconazole or fluconazole can be used
Looks like tinea without superficial scale
Granuloma Annulare
- No treatment needed
Two serious rare side-effects of Minocycline
Autoimmune hepatitis and SLE
Normal amount of hair loss/day
50-100 scalp hairs/day
Anagen Effluvium
- Marked decrease in production of new hairs (anagen phase) leading to profound hair loss
- 2/2 chemo or radiation
Telogen Effluvium
- Diffuse thinning of hair
- Increased % of telogen hair
- Hair grows back completely within months
- Congenital, focal absence of skin (any skin structure)
- Most common on scalp, but also on face, trunk and extremity
- Deep lesions can extend to dura or meninges
Aplasia Cutis Congenita
membranous appearance with a ring of long, coarse, dark hair (“Hair collar sign”) associated with underlying CNS malformations
Two syndromes often associated with aplasia cutis
Trisomy 13 and 4p-
- Present at birth or develops in infancy
- Sharply defined, unilateral or localized, hypopigmented patch
- 2/2 inadequate melanin production or transfer
Nevus Depigmentus
- White forelock/piebaldism
- Iris heterochromia
- Dystopia canthorum
- SNHL
- Hirschsprung Disease
Waardenburg Syndrome
Erythema Multiforme precipitating factors
HSV, Mycoplasma, drugs
Drugs associated with SJS
NSAIDs
Anticonvulsants
Antibiotics
Allopurinol
Started typically 1-8 weeks prior to onset of disease
Erythema Nodosum associations
- GAS, TB, Mycoplasma, EBV, coccidiomycosis, yersinia
- IBD, Behcet disease, sarcoidosis
These vaccines contain egg antigen
Influenza
Rabies
This vaccine contain yeast protein
Hepatitis B
These vaccines contain neomycin
MMR
IPV
Varicella
This vaccine contains streptomycin
IPV
These are live vaccines
MMR
Varicella
- Acute febrile illness
- Prior allergic reaction to same or related vaccine
- Prior serious reaction to same vaccine
Vaccine Contraindications
Immunosuppressive therapy or immunodeficiency disorder is a general contraindication for _____
Live vaccines
Pregnant women cannot get this type of vaccine
Live vaccines
Recent IVIG, plasma or blood administration are contraindications for ____
MMR & Varicella vaccines
This age group has a poor response to polysaccharide vaccines
<2 years of age
Hepatitis A Immune Globulin needs to be given within __ days of exposure
14 days
Measles Immune Globulin needs to be given within __ days of exposure
6 days
Wound plus <3 past tetanus immunizations
- Immunize
- TIG for “dirty” wounds early
Wound plus >= 3 past tetanus immunizations
- Dirty wounds - Immunize if >5yrs after last dose
- Clean wounds - Immunize if >10yrs after last dose
- TIG not indicated
Efficacy of DTaP vaccine against pertussis
80-95% after 3 doses
Preterm infants and Hepatitis B vaccine
- Reduced immune response to birth dose
- Give when 2kg or 30 days of age
Serogroups in the MCV vaccine
A, C, Y, W-135
This vaccine may contain latex
MCV
What types of HPV are high risk for cervical cancer
16, 18 >70% cases
Types of HPV –> genital warts
6, 11 ~90%
The currently licensed Haemophilus influenza type B (Hib) vaccine is a ____
Polysaccharide-protein conjugate
This vaccine is associated with rare transient thrombocytopenia
Measles vaccine
This vaccine contains gelatin and neomycin
Measles vaccine
Reason to give a newborn VZIG
Maternal onset 5 days before or 2 days post-delivery
Most common manifestations of lupus
Nephritis, arthritis and dermatitis
Sensitive marker of SLE
ANA
- Also low C3, C4, CH50
Best lupus marker
dsDNA
Most specific Ab for lupus
Anti-Sm
anti-RNP
Mixed Connective Tissue Disease
Anti-SSA/SSB
Sjogren’s syndrome
Anti-histone
Drug induced SLE
This organ involvement establishes overall prognosis of lupus
Kidneys
- decreased complement or increased anti-dsDNA suggests worsening renal disease
12y/o with arthralgias, fever, pleural effusions and pericarditis. CBC shows a Hbg of 8. Urinalysis shows microscopic hematuria and proteinuria. What is the most likely diagnosis?
SLE
Most common manifestations of neonatal lupus
54% heart block 37% rash (E. annulare) 8% hepatitis 6% cytopenias - Most women have no symptoms of lupus - Linked to anti-Ro or anti-La antibodies
Evanescent, salmon-colored rash with Koebner phenomenon, associated with fever spikes
Systemic JIA (Still’s DIsease)
- Aphthous and genital ulcers
- Uveitis
- Arthritis
- Mediterranean, Japanese and Middle Eastern populations
Behcet’s SYndrome
- Periodic fever episodes associated with arthritis, serositis or rash during episodes
- Mediterranean populations
FMF
- Colchicine is highly effective and response virtually diagnostics
The likelihood that a diseased patient has a positive test
Sensitivity
The likelihood that a healthy patient has a negative test
Specificity
Gymnast + low back pain worsened by hyperextension
Spondylolysis
When you think there is a significant difference when there really isn’t
Type I Error (probability of type I error = p value)
When you could not reject the null hypothesis, but in reality, there is a difference
Type II error