Peds 32 Flashcards
Patient has 3-5 days of febrile illness. As the fever resolves, patient develop a pink, maculopapular rash that starts on the trunk and may spread to the face and extremities. What is the most likely dx? Cause?
Roseola - a viral exanthem
Human herpes virus-6 (HHV6)
A child comes in with lesions that are papular 3-10 mm in diameter. The child says they noticed the rash after playing outside and it itches. They think they may have gotten bitten by an insect. What is the most likely dx?
Papular urticaria
A child comes in with fever and rash that you note is fine, erythematous, sandpaper-like and is accentuated at skin creases. What is the most likely dx?
Streptococcal infection (also known as urticarial rash)
A child comes in with a symmetrical rash that starts as dusky red macules and evolves into sharply demarcated wheals and then into target-like lesions. The rash has been present for about 3 weeks and is always present, it does not come and go. What is the most likely dx? Causes?
Erythema multiforme
Herpes simplex infection, medications
A child comes in with a rash that starts on the face with a “slapped” cheek appearance followed by a reticular (lacy) erythematous rash on the trunk and extremities. What is the most likely dx? Cause?
Erythema infectiosum (Fifth disease)
Parovirus B19
Intensely pruritic, circumscribed, raised, erythematous wheal, often with central pallor. Usually asymmetric. The lesions continually change, with new lesions occurring as old ones resolve. Individual lesions tend to last only 12-24 hours. What is the most likely dx?
Urticaria due to type 1 hypersensitivity
A child comes in reporting they were just bit by a tick. You notice a red papular at the site of the tick bite and that it is beginning to expand to form a large erythematous annular patch. What is the most likely dx?
Erythema migrans -> Lyme disease
What does the atopic triad consist of?
Atopic dermatitis (Eczema) Asthma Allergic rhinitis (hay fever)
3 month old female with a rash on scalp. You notice a waxy yellow scale with some mild erythema on her scalp. There are no other rashes anywhere else on the body. Family has tried baby shampoo and using a fine toothed comb, which does not seem to work and only made it redder. They’ve also tried olive oil and petroleum jelly (vaseline), but that just made her greasy. What is your leading differential? Treatment?
Seborrheic dermatitis (“cradle cap”)
Tx:
- baby oil and small brush to remove scales
- frequent daily shampoo with gentle baby shampoo or Rx shampoo containing ketoconazole (an antifungal) or pyrithione zinc
- low potency topical steroid cream (hydrocortisone)
An infant presents with an area of erythema in the inguinal region, as well as erythematous papules and plaques with satellite lesions. What’s the leading dx? Tx?
Candidal rash
Tx: topical nystatin, clotrimazole, miconazole, or ketoconazole
5 year old female with a rash that comes and goes, most often appearing on her legs, arms, or body. It can be really itchy or not seem to bother her much. Today, she was playing with the neighbor’s dog when she started scratching her arm. Family hx pertinent for sister with asthma and father with eczema. Calamine lotion and benadryl seem to help. One exam, you note a rash on the ventral surface of her left arm that is erythematous and slightly edematous. There are multiple plaques, which are mostly oval and some seem to be confluent, consistent with wheals.
What is the leading differential? Treatment?
Acute urticaria (hives).
Tx: Avoid suspected allergens, OTC benadryl or Rx hydroxyzine, Keep cool and calm - cool soothing baths for itch
13 year old with a 3 week itchy rash below his belly button. He reports that he’s tried lotion and OTC hydrocortisone, but it hasn’t gotten better and now it’s brown and starting to crack. On exam, you note a well circumscribed 4cm x 2-3cm plaque near his umbilicus that is erythematous and scaly. It appears to be perfectly in line with the button his jeans and upon further questioning, he says that he got new jeans about 2-3 weeks ago and has been wearing them almost every day.
What is your leading diagnosis? Treatment?
Chronic nickel contact dermatitis
Tx:
- Avoid nickel (found in many jewelry and buttons)
- While the rash is healing, apply a good emollient (such as petroleum jelly [Vaseline]) or a quality skin lubricating cream [such as Aquaphor or Eucerin]).
- A medium-potency topical steroid ointment (BID x 2wks) may also be used to help the rash to resolve.
A child presents with a rash that is “weepy” and has honey-colored crusts on it.
What’s the most likely dx? Tx?
Impetigo - bacterial infection
Mupirocin
16 year old with acne. He’s tried OTC benzoyl peroxide and cleanser with salicylic acid, but stopped d/t worsening skin irritation. His PCP then prescribed tretinoin and clindamycin gel that he’s been using daily as instructed, but says his acne has only gotten minimally better. On exam, you note open and closed comedones, multiple plaques and pustiles scattered over his forehead and chin. There are no cysts.
What would be a suggested next step in his acne tx?
PO abx trial - doxycycline
What’s the first line tx for pediculosis capitis (head lice)?
1% Permethrin lotion
13 month old with a rash x1 week. It is worse on his belly, hands and feet. He scratches at it, especially at night and it really appears to bother him. No fever, otherwise well, eating and voiding normally. He is an only child and attends day care. On exam, you note a rash that appears to be a pustular eruption on his trunk, palms, and soles. On further questioning, his parents also admit their hands and trunk are itchy too. You take a look at the areas they point out and note linear lesions on mom’s fingers and dad’s abdomen.
What is your leading diagnosis? Treatment?
Scabies
Tx: Permethrin 5% cream, 2 applications, 1 week apart from each other for all members of affected household
An infant comes in with an erythematous rash that has a thick non waxy scale and more defined borders. It is sometimes itchy and sometimes not. There is a family hx of a similar type of rash.
What is your leading diagnosis?
Psoriasis
A child comes in with a pruritic rash that is annular, well circumscribed with scaly appearance, raised borders, and a center that is brown or hypopigmented. The child had recent contact with animals, but is otherwise well.
What is your leading diagnosis? How would you confirm the dx?
Tinea Corporis (ringworm) - fungal infection
KOH wet mount exam of skin scrapings
