Peds - Derm II

Question 1

A common, benign, hyperproliferative inflammatory skin disorder

Answer 1

Psoriasis

Question 2

Psoriasis - what’s going on?

4

Answer 2

o Epidermal turnover time is reduced from 14 days to 2 days
o Keratinazation doesn’t occur
o Immature NUCLEATED cells are seen on the horny layer
o May be immunologically mediated

Question 3

Psoriasis - typical lesion

Answer 3

Lesions are red, sharply defined plaques with silvery scales

Question 4

Psoriasis - hallmark sign

Answer 4

Auspitz’s sign - droplets of blood when scale is lifted

Question 5

Psoriasis - management

Answer 5

o Topicals for the scalp = tar, salicylic acid
o Topical steroids for the skin = betamethasone, - triamcinolone
o If severe - UVB light, coal tar exposure

Question 6

Pityriasis rosea - cause and timing

Answer 6

o thought to be viral
o more common in spring and fall
o often patients report a recent URI

Question 7

Pityriasis rosea -

duration

Answer 7

3-8 weeks, self-limiting

Question 8

Pityriasis rosea -

differential, especially if no itching or if palmar/plantar are involved

Answer 8

syphillis

Question 9

Management of pityriasis rosea pruritis (3)

Answer 9

o oral antihistamines (atarax/hydroxizine, claritin)
o topical antipruritic
o topical steroids (triamcinolone)

Question 10

Examples of topical antipruritics (4)

Answer 10

Sarna lotion
Prax lotion
Itch-x gel
Cetaphil with menthol

Question 11

What oral antibiotic can be used to dry up the lesions of pityriasis rosea?

Answer 11

Erythromycin x 14 days

Question 12

Impetigo - typically caused by which gram positive organisms?

Answer 12

strep

staph

Question 13

Impetigo - pharmacotherapy for MILD cases

Answer 13

Bactroban

Bacitracin

Question 14

Impetigo - PO pharmacotherapy for more SEVERE cases

Answer 14

strep –> erythromycin or PCN

staph –> erythromycin or cephalexin

Question 15

Impetigo - pharmacotherapy for cellulitis

3

Answer 15

IV ABT
o nafcillin
o vancomycin
o doxycycline

Question 16

Scabies - incubation

Answer 16

4 - 6 weeks

Question 17

Scabies management (2)

Answer 17

Permethrin (Nix) - repeat in 1 week
or
Ivermectin - do not use in pregnant, lactating - kills eggs so can cross blood-brain barrier

Question 18

A spirochetal disease; the most common vector-borne disease in US

Answer 18

Lyme disease

Question 19

Lyme disease organism

Answer 19

Borrelia burgdorferi

Question 20

Lyme disease - stage 1

2

Answer 20

Erythema migrans

Flu-like s/sx

Question 21

Lyme disease - stage 2

3

Answer 21

Headache
Stiff joints
Bell’s palsy

Question 22

Lyme disease - stage 3

3

Answer 22

Joint pain
Subacute encephalopathy
Acrodermatitis chronicum atrophicans

Question 23

Acrodermatitis chronicum atrophicans

Answer 23

Associated with Lyme disease

Blue-red discoloration of distal extremity with edema

Question 24

Lyme disease -

Which antibody detection test is initially done?

Answer 24

ELISA

Question 25

Lyme disease -

What test is confirmatory?

Answer 25

Western blot assay

Question 26

Lyme disease -

Is ESR likely to be elevated?

Answer 26

Yes

Question 27

Lyme disease -

Diagnostic criteria

Answer 27

Exposure to tick habitat in past 30 days AND
o erythema migrans OR
o late manifestation AND
o lab confirmation

Question 28

Lyme disease -

Management if SKIN symptoms only –>

Answer 28

Doxy if over 7 years of age

amoxicillin or cefuroxime if not

Question 29

Lyme disease -

Management of stage 2 or 3

Answer 29

Refer to infectious disease specialist

Question 30

Possible acute complications of Rubeola (4)

Answer 30

ear infection
pneumonia
encephalitis
acute thrombocytopenic purpura

Question 31

Possible chronic complication of Rubeola (1)

Answer 31

Chronic brain disease - subacute sclerosing panencephalitis

Question 32

Acute, contagious viral disease known for its teratogenicity

Answer 32

Rubella / 3-day measles / German measles

Question 33

Characteristic rash of Rubella

Answer 33

Fine, erythematous papular rash which starts on FACE

Spreads to extremities and trunk

Question 34

Location of Rubellar lymphadenopathy

Answer 34

post auricular

sub occipital

Question 35

Fever, runny nose, cough, red eyes, spreading skin rash, Koplik’s spots, highly contagious

Answer 35

Rubeola / ordinary measles

Question 36

Erythematous maculopapular rash which starts on face and spreads, gone in 72 hours

Answer 36

Rubella / 3-day measles / German measles

Question 37

URI symptoms, rash on trunk then extremities, high fever with ABRUPT END when RASH develops; seen in 6 month - 2 year olds

Answer 37

Sixth disease / Roseola infantum

Question 38

A contagious exanthematous disease caused by human parvovirus B19.

Answer 38

Erythema Infectiosum

Question 39

Fifth disease - diagnostics

Answer 39

Can test for B19 IgG, IgM

Question 40

How can pregnant women exposed to Fifth disease be treated to protect the fetus?

Answer 40

Immunoglobulin

Question 41

What can intrauterine infection with fifth disease cause?

Answer 41

fatal anemia

Question 42

Sixth disease / Roseola infantum - pathogen

Answer 42

Human herpesvirus 6 (HHV-6)

Question 43

A highly contagious, viral illness resulting in uleration and inflammation of the soft palate (herpangina) and papulovesicular exanthem on hands and feet.

Answer 43

Coxsackie virus / Hand-Foot-and-Mouth