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Fitzpatrick's Dermatology, 9th Edition (Entrance Exam / Board Exam Prep) > 104: Pediatric Ascolescent Dermatology > Flashcards

104: Pediatric Ascolescent Dermatology Flashcards

(103 cards)

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1
Q

What is crucial when working with pediatric patients and their families?

A

Working with parents/caregivers and understanding the home situation is crucial.

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2
Q

What should be considered when examining infants and children?

A

Examinations should be thorough, including checking all creases and valleys of body folds, and addressing underlying problems such as food intolerances or allergies.

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3
Q

What are some common cutaneous findings in infants that may indicate underlying conditions?

A

Common findings include vascular stains, which may indicate hemangiomas, and midline lesions that may have CNS connections and should not be biopsied without proper evaluation.

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4
Q

What is the typical resolution pattern for telogen effluvium in infants?

A

Telogen effluvium may be gradual or sudden, typically occurring in the first few days after birth, with spontaneous resolution being the rule.

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5
Q

What distinguishes triangular temporal alopecia from alopecia areata?

A

Triangular temporal alopecia is characterized by its typical location, presence of vellus hairs, absence of exclamation point hairs, and specific histologic findings, and it is benign and will not expand.

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6
Q

What is the incidence of alopecia areata in children younger than 2 years of age?

A

The incidence of alopecia areata in children younger than 2 years of age is approximately 1-2%.

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7
Q

Should patch testing or biopsies be avoided in pediatric patients?

A

They should not be avoided simply because of a pediatric patient’s age.

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8
Q

What are some common cutaneous changes that may not be visible at birth?

A

Nevus depigmentosus and epidermal nevus may not be visible until early childhood.

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9
Q

What is telogen effluvium and when does it typically occur?

A

Telogen effluvium may be gradual or sudden and occurs in the first few days after birth with telogen hairs shed by 3-4 months of age.

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10
Q

What is nevus sebaceus and where is it commonly found?

A

Nevus sebaceus is a hamartoma of the head and neck, appearing as a waxy, yellowish plaque.

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11
Q

How does the presence of a solitary café-au-lait macule in an infant relate to potential health concerns?

A

A solitary café-au-lait macule is extremely common and benign; however, it raises the possibility of neurofibromatosis type 1 (NF1). Therefore, while it may not be alarming on its own, it warrants further evaluation to rule out associated conditions.

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12
Q

A 3-month-old infant presents with a vascular stain and vasoconstricted macule. What should be your next step?

A

Evaluate for hemangioma as these may be presenting signs.

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13
Q

A 2-year-old child has a triangular-shaped patch of nonscarring alopecia at the frontotemporal scalp. What is the likely diagnosis and management?

A

The likely diagnosis is Triangular Temporal Alopecia (TTA). It is benign, will not expand, and does not require treatment.

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14
Q

What is the most common dermatophyte that causes infantile tinea capitis?

A

Trichophyton tonsurans is the most common dermatophyte associated with infantile tinea capitis.

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15
Q

What is the treatment of choice for tinea capitis?

A

The treatment of choice for tinea capitis is oral griseofulvin.

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16
Q

What benign condition is often seen in young girls associated with constipation and can be treated with a high-fiber diet?

A

Infantile perineal protrusion is a benign condition seen in young girls that can be associated with constipation and treated with a high-fiber diet.

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17
Q

What is the prognosis of trichotillomania in infants compared to adolescents and adults?

A

Trichotillomania in infants has a good prognosis, whereas hair pulling in adolescents and adults has a much poorer prognosis.

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18
Q

What is the most common dermatologic condition in babies and children?

A

Diaper dermatitis is one of the most common dermatologic conditions in babies and children, accounting for approximately 1 million pediatric consultations each year.

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19
Q

What is a characteristic feature of infantile granular parakeratosis?

A

Bilateral linear plaques in the inguinal folds.

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20
Q

What should be avoided during an examination of a young child?

A

Early prolonged or intense eye contact.

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21
Q

What is the recommended position for examining the perineum and genitalia of a child?

A

Knee-chest position on the table or the parent’s lap.

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22
Q

What is a common mistake when interpreting genital examination in infants?

A

Mistaking infantile perianal pyramidal protrusion for condyloma acuminata.

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23
Q

What are the potential dangers associated with biopsies in infants and children?

A
  • Possible intracranial connection with biopsies or scrapings
  • Risk of meningitis with biopsy
  • Spina bifida occulta and meningomyelocele risks
  • Intracranial connection in 100% of encephaloceles and gliomas may extend into nearby structures.
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24
Q

What is the maximum dosing for EMLA cream in children of different age groups?

A
  • 1 - 3 months: 1g
  • 3 - 12 months: 2g
  • 1 - 6 years: 10g
  • 7 - 12 years: 12g
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25
What are some alternative pain management techniques for young children undergoing procedures?
- **Numb with ice** or anesthetic cryospray - **Pacifier dipped in sucrose solution** - **Baby swaddling** - **Distraction techniques** (e.g., music or movies) - **Alkalizing local anesthetics** to pH 7 - **Warming lidocaine** to lessen pain - **Gentle vibrational motions** during injection.
26
What are the top allergens identified in pediatric patch testing?
- Nickel: 22% - Fragrance mix 1: 11% - Cobalt: 9.1% - Balsam of Peru: 8% - Neomycin: 7% - Propylene glycol: 7% - Cocamidopropyl betaine: 6% - Bacitracin: 6% - Formaldehyde: 6% - Gold: 6%
27
What strategies can be employed to ensure successful patch testing in children?
- Have the child **stand up straight** - Use **Hypafix tape** or other dressings to ensure patches stay in place - Advise to **avoid sports or gym class** to prevent sweating or movement.
28
What is a common concern regarding biopsies in infants and children?
There has been a widespread reluctance to biopsy skin lesions, which may lead to a delay in diagnosis.
29
What is the purpose of using EMLA cream in pediatric procedures?
To minimize pain during procedures.
30
What is a potential risk associated with the use of EMLA cream?
It can result in methemoglobinemia and seizures.
31
What is the maximum dose of EMLA cream for a child aged 1-3 months?
1g.
32
What is the prevalence of sensitization among children with suspected allergic contact dermatitis (ACD)?
65%.
33
What should be considered when performing general anesthesia in healthy pediatric patients?
Weigh the risks and benefits, especially regarding the developing brain of young children.
34
What is a recommended technique for obtaining an MRI in infants?
Use 'Feed and swaddle' techniques to keep the baby motionless during the procedure.
35
What are the potential dangers associated with performing biopsies on infants and young children, and how can these risks be mitigated?
Potential dangers include: - **Intracranial connection** risks with certain lesions (e.g., dermoid cysts, nasal masses). - **Risk of meningitis** with biopsies or scrapes. Mitigation strategies: - **Preoperative imaging** (e.g., MRI) to assess risks. - **Consultation with specialists** (e.g., neurosurgical). - **Proper management** techniques to minimize risks during the procedure.
36
What are the recommended maximum doses of EMLA cream for different age groups in pediatric patients, and what precautions should be taken when using it?
Maximum doses of EMLA cream: - **1-3 months:** 1g - **3-12 months:** 2g - **1-6 years:** 10g - **7-12 years:** 12g Precautions: - Increased absorption on **diseased skin** can lead to toxicity. - Monitor for **methemoglobinemia** and seizures as potential side effects.
37
What limits the number of patches that can be placed on a child's back?
The smaller surface area of the back in children may limit the number of patches.
38
What alternative can reduce pain for a newborn undergoing venipuncture?
A pacifier dipped in sucrose solution has been found superior to topical EMLA.
39
What is the maximum dose of lidocaine for a 10-month-old baby weighing 10 kg?
The maximum dose is 2 grams.
40
What are the top three allergens to test for in suspected allergic contact dermatitis?
Nickel (22%), Fragrance mix 1 (11%), and Cobalt (9.1%).
41
What should you suspect in a 6-year-old with a new rash after using a topical cream?
Suspect allergic contact dermatitis (ACD).
42
What should clinicians inform adolescent patients about confidentiality?
Confidentiality will be respected, but cannot be guaranteed.
43
What must physicians report by law regarding adolescents?
Situations involving potential abuse or suicidal ideation.
44
What techniques can help earn the trust of adolescent patients?
Greet the adolescent first, interview alone, and use open-ended questions.
45
What are the recommended oral contraceptive pills for acne management?
FDA approved OCPs include Yaz, Ortho-Tricyclen, and Yazmin.
46
What should patients be counseled about when prescribed OCPs for acne?
Adhere to 3 months of OCPs to establish treatment efficacy.
47
What psychiatric effects are associated with isotretinoin use in adolescents?
Reports of depression, suicide, and other psychiatric effects.
48
What is the physician's role in the care of adolescent patients?
To be a trusted, valuable authority.
49
What should be monitored in patients receiving spironolactone and drospirenone?
Potassium levels may need to be monitored.
50
What is a common issue with adolescents taking oral contraceptives?
Many adolescents forget to take their birth control pills regularly.
51
What are the key considerations for maintaining confidentiality in adolescent healthcare?
Respect the patient's right to privacy and inform about limitations.
52
What should a physician do if there is potential for abuse in an adolescent?
Report such situations as required by law.
53
What is an effective technique for interviewing adolescents?
Using open-ended questions and phrasing in the third person.
54
What are the potential effects of acne on adolescents?
Acne can have detrimental effects on self-image and self-esteem.
55
What are the risks associated with isotretinoin in adolescents?
Isotretinoin can lead to idiosyncratic psychiatric reactions.
56
What is the most common form of hyperhidrosis seen in adolescents?
Axillary hyperhidrosis
57
What are the management options for axillary hyperhidrosis?
Glycopyrrolate, oxybutynin, and botulinum toxin A if primary treatment fails.
58
What are the risks associated with indoor tanning?
Increases risk for melanoma and non-melanoma skin cancer.
59
What psychological effects can indoor tanning have?
It can be physiologically and psychologically addictive.
60
What is the prevalence of Autism Spectrum Disorder (ASD) in boys compared to girls?
ASD is 4-5 times more common in boys than girls.
61
What do the early signs of Autism Spectrum Disorder emerge?
The clearest signs tend to emerge between 2-3 years of age.
62
What factors contribute to the development of Autism Spectrum Disorder?
Genetic predisposition, pregnancy and environmental influences, and early developmental factors.
63
What is the role of medical diagnostic tests in diagnosing Autism Spectrum Disorder?
There is no medical diagnostic test; diagnosis relies on developmental and clinical signs.
64
What are common skin findings in children with Autism Spectrum Disorder?
Scars/callous formation, xerosis, and atopic dermatitis.
65
What are the implications of the lack of FDA labeling for pediatric medications?
Insufficient data for drug approval and increased malpractice risk.
66
What are the risks associated with topical medications in infants and young children?
Increased toxicity risks due to higher surface-area-to-body-mass ratio.
67
What are the risks associated with topical medications in infants and young children?
Infants and young children face increased risks due to: - Increased surface-area-to-body-mass ratio leading to higher toxicity risks. - Altered drug metabolism in children. - Increased percutaneous absorption resulting in: - Disorders of cornification (e.g., lamellar ichthyosis). - Skin barrier disruption (e.g., Netherton syndrome), which can lead to immunosuppressive effects from topical tacrolimus.
68
What are the potential effects of systemic glucocorticoids on growth in children?
Systemic glucocorticoids can lead to: - Growth suppression unique to childhood due to disruption of growth hormone secretion. - Effects include: 1. Abnormal spontaneous growth hormone secretion with reduced pulse amplitude. 2. Reduced response to stimuli. 3. Decreased local production of insulin-like growth factor 1 (IGF-1). - These effects can cause delayed growth at the bony epiphyses, particularly noticeable during early childhood and adolescent growth spurts.
69
What are some neurobehavioral dermatoses associated with autism?
They include scars, callosities, and self-inflicted injury resulting from repetitive or ritualistic behaviors.
70
What nutritional disorders may develop in children with autism?
Nutritional disorders such as scurvy can develop either from eating preferences or imposed dietary restrictions.
71
What is the significance of the Pediatric Exclusivity Provision?
It provides marketing incentives to manufacturers who conduct studies of drugs in children, increasing labeling information.
72
What complications can arise from using topical tacrolimus in children?
Children may develop immunosuppressive or toxic blood levels of tacrolimus without clinical signs of toxicity.
73
What is a common cause of dosing errors in pediatric medication?
Using dosing cups is a common cause of dosing errors, being almost five times more likely than using oral measuring syringes.
74
What potential risk is unique to childhood when using systemic glucocorticoids?
The potential risk of growth suppression due to disruption of growth hormone secretion.
75
What are the implications of sensory processing disorders in pediatric dermatology, particularly in children with autism?
Sensory processing disorders can lead to hypersensitivity and hyposensitivity to stimuli, which may result in tactile defensiveness and an inability to tolerate topical medications or emollients. This can complicate dermatological care for children with autism, as they may also exhibit neurobehavioral dermatoses and nutritional disorders due to dietary restrictions.
76
How does the lack of FDA labeling for pediatric use impact the prescription of medications in children?
The lack of FDA labeling for pediatric use means that there is insufficient data available to grant approval status for many medications. This can lead to malpractice if off-label uses are prescribed without adequate evidence. Approximately 50% to 75% of drugs used in pediatrics have not been studied adequately, posing significant safety risks, especially for younger patients.
77
A child with autism spectrum disorder (ASD) is resistant to topical medications. What could be the reason?
Sensory dysfunction, including hypersensitivity or tactile defensiveness, may make it difficult for the child to tolerate topical medications.
78
A child with Netherton syndrome is treated with topical tacrolimus. What complications should you monitor for?
Monitor for immunosuppressive or toxic blood levels of tacrolimus, even without clinical signs of toxicity.
79
A child with autism has scars and self-inflicted injuries. What could be the underlying cause?
These may result from repetitive, ritualistic, or stimulatory behaviors associated with neurobehavioral dermatoses.
80
A child with a history of dietary restrictions develops scurvy. What could be the contributing factors?
Nutritional disorders may develop due to eating preferences or imposed dietary restrictions such as gluten-free or ketogenic diets.
81
What is the relationship between daily dose and growth suppression in children taking glucocorticoids?
There is a linear relationship; alternate-day dosing with a single morning dose may decrease the risk.
82
What should children on immunosuppressive doses of glucocorticoids not receive?
Live-virus vaccines such as measles, oral polio, and varicella.
83
What are the two FDA-approved agents for tinea capitis in children?
Griseofulvin and terbinafine oral granules.
84
What is the first line therapy for tinea capitis in children?
Griseofulvin for 6-8 weeks.
85
What are the risk factors for child maltreatment?
Children with special needs, caregiver stress, inadequate parenting skills, and poverty are among the risk factors.
86
What percentage of abused children have suggestive dermatologic findings?
90%.
87
What is the importance of timely reporting in cases of suspected child abuse?
It is required by law to ensure the safety of the child.
88
What are the four categories of child maltreatment?
Physical, sexual, psychological, and neglect.
89
A 5-year-old child is prescribed a liquid medication. What instructions should you provide to the parents?
Ensure the prescription indicates the concentration (e.g., mg per 5 mL) and provide a measuring instrument with education on its use.
90
A child on immunosuppressive doses of glucocorticoids is exposed to varicella. What should you do?
Do not administer live-virus vaccines and take precautions as varicella can be fatal in this situation.
91
A child with tinea capitis is prescribed griseofulvin. What is the recommended dose?
20 mg/kg/day of the liquid (125 mg/5 mL) or 15 mg/kg/day of the ultramicrosized tablets for 6-8 weeks.
92
A child with suspected abuse has dermatologic findings. What is your legal obligation?
Ensure the immediate safety of the child, document findings objectively, and report to child protective services as required by law.
93
A 6-year-old child is prescribed a systemic antimicrobial. Why should tetracyclines be avoided?
Tetracyclines are contraindicated in children under 8 years old as they cause brown discoloration of teeth and decreased bone growth.
94
What are some characteristics of autism that may affect interactions with children during medical visits?
Characteristics of autism that may affect interactions include: - Predictable behaviors: Children may have predictable responses to behavioral triggers. - Sensory sensitivities: Some children may be sensitive to sounds, lights, or touch. - Communication styles: Children may have difficulties with verbal communication and may be more receptive to nonverbal cues. - Ritualistic behaviors: Children may prefer routines and familiar environments.
95
What strategies can be employed to effectively care for children with autism during medical visits?
Strategies for caring for children with autism include: - Preparation: Prepare the family in advance and keep to the schedule. - Environment: Minimize sensory overload by adjusting lighting and sounds. - Communication: Use nonverbal communication and clear instructions. - Patience: Be patient with the child and the family, as each visit may differ. - Involvement: Involve the parent/caregiver in strategies that work best for the child.
96
What should be avoided when caring for children with autism in a medical setting?
Avoid the following when caring for children with autism: - Assuming that all children will respond the same way to procedures. - Forcing the child into situations that may cause distress, such as closed doors. - Overlooking the need for tailored communication strategies. - Rushing through procedures without considering the child's comfort and understanding.
97
What should be done to prepare a child with autism for a medical appointment?
The family should be informed to wait instead of the waiting room, and the appointment should be scheduled at a time convenient for the child.
98
What should caregivers avoid assuming about children with autism during medical procedures?
Caregivers should not assume that general anesthesia is needed for every procedure or that the child understands everything being said without acknowledgment.
99
How can caregivers assist children with autism in understanding verbal instructions?
Using nonverbal communication and demonstrating actions can help children understand better than just verbal instructions alone.
100
What is an important consideration regarding the environment for children with autism during medical visits?
Creating a familiar and predictable environment can help reduce anxiety for the child during medical visits.
101
What should be done if a child with autism shows signs of discomfort during a medical visit?
Ask the child about their feelings and adjust the environment or approach accordingly to make them more comfortable.
102
Why is it important to be patient with children with autism during medical visits?
Because not every visit will go the same way, and unexpected challenges may arise that require flexibility and understanding.
103
How can healthcare providers ensure effective communication with children who have Autism Spectrum Disorder during medical procedures?
Healthcare providers can ensure effective communication by: 1. Using Visual Aids: Incorporate visual supports to explain procedures. 2. Simplifying Language: Use clear and simple language, avoiding complex terms. 3. Demonstrating Actions: Physically demonstrate what will happen during the procedure. 4. Allowing Time: Give the child time to process information and respond. 5. Involving Caregivers: Collaborate with parents or caregivers to understand the child's communication style and preferences.

Fitzpatrick's Dermatology, 9th Edition (Entrance Exam / Board Exam Prep) (213 decks)

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