pediatric dermatology

Question 1

blotchy erythematous macules, tiny pustules, vesicles, and papules, starting on face and progressing to trunk/extremities

Answer 1

Reassure patients that this is self limited and will resolve around 10-14 days, this is called erythema toxicum neonatorum, onset is usually 2-10 days old.

Question 2

urticarial red papules rapidly progress to palpable purpura within the first 24 hours
Symmetric involvement in lower legs, buttocks elbows & knees

occurs in children 2-20 years old, group A strep can trigger, tetrad of symptoms;
rash, arthritis, abdominal pain, kidney issues

2-3 weeks of fever, ha, muscle/joint ache

Answer 2

Small vessel vasculitis; henochschonlein purpura

DX- UA- hematuria/proteinuria, renal functions tests repeated regularly, blood pressure monitoring, skin biopsy not necessary

TX-
focus on rehydration and pain management, nsaids, oral steroids if severe

Question 3

palpable purpura with at least on of the following:
diffuse abd pain, arthritis, renal involvement, skin biopsy showing IgA deposition

Answer 3

diagnostic criteria for Henoch-schonlein purpura

Question 4

favors palms/soles and extensor extremities, symmetrical targetoid or iris lesion.

Lesions spread outward and the center becomes dusky purpuric or vesicular,

Answer 4

erythema multiforme

skin biopsy if not confident

RPR to r/o syphilis

Question 5

erythema multiforme treatment

Answer 5

resolves spontaneously, suppressive therapy with accyclovir 400mg for recurrent

Question 6

if scale is present in gluteal cleft think what condition

Answer 6

Kawasaki Disease

Question 7

Children 0-19 years old with fever > 3days and two of the following:
rash/ bilateral nonpurulent conjunctivitis, hypotension/shock/, cardiac involvement, coagulopathy, acute gi distress, w/ elvated ESR/CRP, no other causes of microbial inflammation

Answer 7

MIS-C

Question 8

infant to preschool, occurs in the spring, high fever for 3 days with mild uri symptoms, when fever breaks- erythematous macules/papules with circumoral pallor, high fevers may cause febrile seizures

Answer 8

Roseola
HHV 6&7

Question 9

early school age, occurs later winter-early spring, low grad fever, malaise, sore throat w/ 3 stages:
1. slapped cheeks
2. erythematous patches on the trunk spreading to the extremities, sparring palms/soles
3. Lacey/reticulated pattern as it clears

**can wax/wane for weeks

Answer 9

Erythema Infectiosum
Human Parvovirus B19

Cannot be around pregnant women in 1st to 2nd trimester

Question 10

infant to preschool, common in later summer/early fall, fever sora throat URI, gi distress, rash appears 1-2 days after fever, vesicles on an erythematous base in oral cavity, painful red macules/vesicles present on knees elbows, palms, soles and buttock

Answer 10

Hand, foot, and mouth
coxsackie/enterovirus

magic mouthwash, very contagious, slight risk of miscarriage, still birth, greatest risk near delivery

Question 11

pre and early school age, moderate fever, malaise, conjunctivitis, rhinorrhea, cough, KOPLIK spots on buccal mucosa, morbilliform eruption of erythematous macules/papules, begins on face or behind ear and spreads cephalocaudally, clears after 1 week, possible desquamation

Answer 11

highly infectious Rubeola (measles)

vaccination

maternal risk of premature labor, and fetal loss

increased risk of maternal death

Question 12

ages 5-9 years, rose-pink macules/papules, petechial macules on palate (forchheimer spots) spreads cephalocaudally

Answer 12

Rubella (german measles)

Vaccinate
increased risk in 1st trimester of causing deafness, cataracts and cardiac disease

Question 13

age 5-15, fever, exudative pharyngitis, malaise, cervical lymphadenopathy, generalized red-orange sandpaper eruption, forcheimer spots, strawberry tongue, pastia’s lines, starts on the head and neck and spreads cephalocaudally

Answer 13

scarlet fever

Full 10 days of PCN to prevent rheumatic fever

throat culture
ASO titer
isolate until 24 hours antibiotic administration

Question 14

children under 10, pruritic besicles on erythematous base, progress to crust, accompanied by fever, mucous membrane involvement, starts on scalp and trunk and then spreads centrifugally

Answer 14

varicella (chicken pox)
vaccination
very contagious

Question 15

pin, skin colored or dull red brown papules beginning on the thighs and buttocks spreading to lateral arms and eventually the face, spares the chest, abdomen and back
not itchy

Answer 15

giannotti crosti, papular acrodermatitis

usually occurs after molluscum
mild tcs

Question 16

present at birth or 1-4 weeks old
common tumor of infancy

Answer 16

infantile hemangiomas

Question 17

high risk hemangiomas for infants

Answer 17

periorbital, beard, lumbar midline, mouth or groin, face

Question 18

posterior fossa malformation
hemangioma of cervicofacial region
Aterial anomalies
cardiac anomalies
eye anomalies
sternal or abdominal clefting

Answer 18

PHACES syndrome r/t hemangiomas

Question 19

Lower body hemangioma
urogenital anomalies
myelopathy
bone deformities
anorectal malformations
renal anomalies

Answer 19

lumbar syndome r/t hemangiomas

Question 20

1st line treatment for infantile hemangiomas

Answer 20

oral propanolol 0.6mg/kg BID w/ gradual increase to 2-3mg/kg/day for 3-6months

Question 21

what should patient’s parents monitor for when child is taking propanolol

Answer 21

hypoglycemia, sweating, bradycardia, hypotension, bronchospasms, hypothermia

Question 22

capillary malformation, erythematous macule/patch, usually midlines, may enlarge as patient growns, common on the nape of the neck/occiput or on face, benign

Answer 22

nevus simplex or stork bite

Question 23

present at birth as flat, blanchable pink changing to dark red patches, does not grow rapidly, lesions can bleed spontaneously,

Answer 23

Port Wine Stain

Question 24

what are high risk areas for port wine stains and what are the disease processes associated

Answer 24

eyelids/forehead-congenital glaucoma
forehead-sturge weber
lower back that crosses midline refer to neuro