Case Files 33-34 Flashcards Preview

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Flashcards in Case Files 33-34 Deck (33)
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1
Q

What’s guttate psoriasis?

A

psoriasis variant often following strep infection

sudden eruption of small round or oval psoriatic lesions on trunk, face & prox limbs

2
Q

what’s nummular dermatitis?

A

pruritic boggy or vesicular round lesions erupt on extrems, buttocks and shoulders. If they occur chronically, lichenification can occur

3
Q

what’s pityraisis lichenoides chronica?

A

multi, small (3-5 mm), red-brown papules covered w/ gray scale on trunk and extremities. They can become vesciular, hemorrhagic, crusted, or superinfected. By 2-6 wks become flat and hyper or hypopigmented

4
Q

what’s pityriasis rosea?

A

benign childhood skin eruption of pink oval/round lesions <1cm diameter w/ raised edges & scale on surface. Hearld patch (single lesion 1-10 cm) often noted 5-10 days before generalized eruption along cleavage planes (Christmas tree pattern)

5
Q

what causes pityriasis rosea, how long does it last? how do you tx it?

A

cause unkonwn, but likely viral
lesions last 2-12 wks, usu asymptomatic
Tx: bland emollient, antihistamines or topical corticosteroids if pruritus

6
Q

what’s an import differential for pityriasis rosea?

A

secondary syphilis esp if sexually active adolescent & lesions on palms or soles

7
Q

what helps you distinguish pityriais lichenoides chronica from pityriasis rosea?

A

lack of herald patch and chronicity of the lesions

8
Q

what’s tinea corporis?

A

ringworm
superficial cutaneous fungal infection caused y Microsporum canis, trichophytom tonsuran, rubrum or metagrophytes.
erythematous papule that expands to curcular, scaly, erythematous lesion w/ raised borders. central clearing and pruritus is possible

9
Q

how do you treat tinea corporis?

A

topical azoles - Ketoconazole, clotrimazole or systemic antifungals - griseofulvin

10
Q

what’s pityriasis alba?

A

hypopigmented macules w/ fine scale usu on face, neck, upper trunk and prox upper extrems

11
Q

What’s Wiskott-Aldrich syndrome?

A

rare X-linked disorder of recurrent bacterial infections, bleeding secondary to thrombocytopenia w/ platelet dysfxn, chronic dermatitis. can lead to autoimmune hemolytic anema. Need BM transplant or die by 3 yo

12
Q

What’s brudzinski sign?

A

pt is supine, neck’s passively flexed resulting in involuntary knee and hip flexion. PE finding in meningitis

13
Q

what’s encephalitis

A

brain parenchyma inflammation causing brain dysfxn

14
Q

what’s kernig sign?

A

pt’s supine, legs are flexed at hip and knee at 90 degree resulting in pain w/ leg extension - consistent w/ meningitis

15
Q

what’s meningitis

A

leptomeningeal inflammations, usu infectious

16
Q

what are the MC causes of neonatal meningitis?

A

E. coli and GBS (S. agalactiae)

17
Q

what are increased risks for neonatal meningitis?

A

low birth weight, preterm, mom w/ chorioamnionitis, prolonged ROM, traumatic delivery

18
Q

how does most neonatal bacterial meningitis occur?

A

hematogenous spread

19
Q

what are symptoms of neonatal menigntis?

A

thermal instability (usu hypothermic), poor feeding, emesis, seizures, irritable, apnea, bulging fontanelle, hyper or hypotonicity

20
Q

what are the MC causes of bacterial meningitis in older kids?

A

Strep pneumoniae or Neisseria meningitidis (unvaccinated - H. influenzae type B)

21
Q

Who’s at higher risk for bacterial meningitis in older kids?

A

kids w/ poorly fxning or absent spleen or w/ sickle cell b/c Staph pneumoniae is an encapsulated bacteria (MC in winter)

22
Q

What are risk factors for bacterial meningitis in older kids?

A

Asplenic, sickle cell, sinusitis, otitis media, pneumonia, head trauma w/ CSF leak

23
Q

what are classic symptoms of meningitis in older kids and adults?

A

mental status changes, N/V, lethargy, restlessness, ataxia, back pain, + kernig and brudzinski signs, CN palsies, seizures

24
Q

If a pt has N. meningitidis meningitis what else might they have?

A

petechial or purpuric rash assoc w/ septicemia - gravely ill

25
Q

How do you test for meningitis?

A

Lumbar puncture

26
Q

what are contraindcations for lumbar puncture?

A

skin infection over planned puncture site, evidence or concern for increased ICP, critcally ill who can’t tolerate it

27
Q

What’s included in a CSF analysis?

A

gram stain and culture, WBC and RBC counts, protein and glucose analysis. Can do bacterial antigen screens even if already receiving Abx b/c antigens may persist for several days even if culture is negative

28
Q

what are typical findings from LP in pt w/ bacterial menigntis?

A

elevated opening pressure, 100s to 1,000s of WBCs w/ PMN cell predominance, elevated protein, decreased glucose

29
Q

what’s the MC tx for neonatal bacterial meningitis?

A

Ampicillin w/ 3rd generation cephalosporin or aminoglycoside to cover GBS, L. monocytogens and E.coli

30
Q

How would you treat suspected pneumococcal meningitis?

A

3rd generation cephalosporin plus vancomycin (b/c of high penicillin resistance)

31
Q

What are most N. meningitidis strains susceptible to?

A

penicillin or cephalosporins

32
Q

What are acute meningitis complciations?

A

seizures, CN palsies, cerebral infarction, cerebral or cerebellar herniation, venous sinus thrombosis, subdural effusions, SIADH w/ hyponatremia, central diabetes insipus, hearing loss

33
Q

what’s the MC long-term sequela w/ acute meningitis, esp w/ pneumococcus?

A

hearing loss