PED- DERM 2 (BENIGN) Flashcards
EXAMPLE- QUESTIONS
A first-time mother brings her 3-day-old full-term newborn to the clinic, concerned about a newly appearing red, blotchy rash on the baby’s chest and face. The rash consists of erythematous macules with central papules but spares the palms and soles.
What is the most appropriate management for this condition? - A) Recommend topical antibiotics. - B) Educate the mother to leave the rash alone as it will typically resolve on its own within 1-2 weeks. - C) Prescribe a mild steroid cream. - D) Advise application of baby oil to soothe the rash.
B) Educate the mother to leave the rash alone as it will typically resolve on its own within 1-2 weeks.
A first-time mother brings her 3-day-old full-term newborn to the clinic, concerned about a newly appearing red, blotchy rash on the baby’s chest and face. The rash consists of erythematous macules with central papules
BUT spares the palms and soles.
What condition is this?
Erythema Toxicum Neonatorum
(newborn rash)
A parent presents their 3-week-old infant who has numerous small, red papules on their cheeks. The parent has been applying baby oil, but the condition has not improved and seems to be worsening.
C) stop using baby oil and reassure that it will resolve spontaneously.
** This is acne neonatorum
A parent brings in their newborn with clusters of yellow/white pustules that are prominent on the soles of the feet. The baby is otherwise well.
Which feature distinguishes this condition from erythema toxicum neonatorum (newborn rash)
- A) Presence of erythematous macules with central vesicles.
- B) Vesicular lesions on the palms and soles.
- C) Blotchy rash sparing the palms and soles.
- D) Requirement for immediate antiviral therapy.
B) Vesicular lesions on the palms and soles.
Transient Neonatal Pustular Melanosis:
A parent brings in their newborn with clusters of yellow/white pustules that are prominent on the soles of the feet. The baby is otherwise well.
What is this condition?
Transient Neonatal Pustular Melanosis:
Parents report a persistent flat, pink mark on the nape of their baby’s neck that becomes more pronounced when the baby cries.
You inform the parents that this is most likely:
- A) A sign of neurofibromatosis.
- B) Harmless and usually fades by 18 months.
- C) Indicative of a capillary hemangioma.
- D) A need for immediate laser treatment.
B) Harmless and usually fades by 18 months.
**Nevus Flammeus (Stork Bite/Salmon Patch)
Parents report a persistent flat, pink mark on the nape of their baby’s neck that becomes more pronounced when the baby cries.
What is this condition of?
Nevus Flammeus (Stork Bite/Salmon Patch)
During a routine check, you note six cafe au lait spots on a prepubertal child, each measuring more than 0.5 cm in diameter. The parent’s family history is significant for neurofibromatosis.
What is the recommended next step in managing this child? - A) Observe the child for any changes. - B) Referral to a pediatric neurologist for further evaluation. - C) Prescribe topical steroids to lighten the spots. - D) Educate parents on annual checkups, monitoring
B) Referral to a pediatric neurologist for further evaluation.
During a routine check, you note six cafe au lait spots on a prepubertal child, each measuring more than 0.5 cm in diameter. The parent’s family history is significant for neurofibromatosis.
What is this condition above describing?
Cafe au Lait Spots and Neurofibromatosis:
A 2-month-old infant has a large, reddish birthmark on the cheek, which has been increasing in size.
What is the most appropriate action given current treatment guidelines for hemangiomas?
- A) Reassure parents that it will disappear by age 2. - B) Prescribe topical propranolol for smaller lesions. - C) Immediate surgical removal. - D) No treatment required and follow-up in a year.
B) Prescribe topical propranolol for smaller lesions.
Compare and contrast milia with sebaceous gland hyperplasia, highlighting how you would differentiate these clinically in a newborn
Milia are small, white, cystic papules (1-2 mm) usually found on the face of approximately 40% of newborns. They represent blocked skin pores and generally disappear by 1-2 months without the need for treatment.
Sebaceous gland hyperplasia presents as white to yellow papules, particularly on the nose. These are caused by an increased number of sebaceous glands at the openings of sebaceous follicles, usually without surrounding erythema. These also resolve without treatment, generally within a few weeks to 4-6 months. **Clinical Differentiation:** - *Milia:* Tends to be more widespread across the face including the cheeks, often smaller, and appear immediately after birth. - *Sebaceous Gland Hyperplasia:* Predominantly found on the nose with a shiny appearance, possibly larger in size, often showing in response to maternal hormones and can stick around longer compared to milia.
Create an education plan for parents of a newborn with congenital melanocytic nevi, focusing on the potential risks and the importance of monitoring.
-
Risk Education: Explain that while most congenital melanocytic nevi (CMN) are benign, there is a 2-5% lifetime risk of malignancy (melanoma), higher in children with CMN larger than 20 cm.
- Surveillance: Stress the importance of regular skin checks and monitoring changes in the size, color, or texture of the nevus, and report these changes to the healthcare provider.
- Specialist Referral: For larger congenital melanocytic nevi, advise seeking assessment from a pediatric dermatologist due to the increased risk of complications.
- Support: Provide reassurance and support resources for managing psychological impacts, such as feelings of distress or stigma.
- Follow-up: Plan routine follow-ups to evaluate the nevus and growth as part of regular pediatric visits.
Analyze why a thorough family history is crucial in evaluating a child with cafe au lait spots for neurofibromatosis.
These questions require you to apply clinical guidelines, educate caregivers, and critically evaluate patient presentations and management plans.
Importance of Family History in Cafe au Lait Spots Evaluation for Neurofibromatosis:**
- Genetic Link: Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder, implying that a family history of the condition significantly increases the risk for the child.
- Diagnostic Criteria: A detailed family history aids in making a precise diagnosis using established criteria that include multiple cafe au lait spots and other neurofibromas.
- Early Detection: Understanding the genetic predisposition enables earlier detection of complications associated with NF1 such as optic gliomas, skeletal abnormalities, and learning disabilities, promoting timely interventions.
- Holistic Management: It helps in framing a comprehensive care plan that involves regular neurological, ophthalmological, and dermatological assessments tailored to the patient’s needs.
- Psychological Support: It ensures family support and genetic counseling, especially in families with a history of NF1, equipping them with critical information to manage the condition effectively.
A 6-year-old girl presents with multiple mosquito bites from a recent camping trip. The bites are significantly pruritic, and despite the application of OTC hydrocortisone cream, the child’s itching and discomfort persist. The mother states that the child has been scratching the areas vigorously. Upon assessment, you notice some redness and swelling around the bites, but no signs of infection. The patient also has a known history of allergies. What would be the most appropriate next step in her management?
Educate the mother on administering an oral antihistamine appropriate for her child’s age and revisit environmental controls to ensure proper protection against further bites. **In this case, oral Diphenhydramine (Benadryl) dosed at 6.25mg every 4-6 hours may be effective. Additionally, reinforce the importance of avoiding scratching to prevent secondary infections
You have a 16-year-old patient come in with second-degree sunburns after spending an entire day at the beach without adequate sun protection. The parent did not apply sunscreen because they believed the teenager “tan well and don’t burn easily.” Your patient has painful erythematous patches with some blistering on the back and shoulders. What should your focused educational point be during this visit?
Educate about the importance of consistent use of broad-spectrum sunscreen with at least SPF 30, proper clothing protection, and seeking shade between 10 AM and 4 PM.
Reinforce how consistent sun protection can prevent both painful burns and long-term damage to the skin. Given the presence of blisters, recommend gentle wound care, hydration, and over-the-counter pain control, and scheduled follow-up if signs of infection develop
