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Peds Exam 2 > Lecture 11 - Derm/ID > Flashcards

Lecture 11 - Derm/ID Flashcards

1
Q

Milia

A

keratin filled papules usually found on the face, without erythema

benign, self-limiting after papules open up

often confused with sebaceous hyperplasia (on nose), or neonatal acne (but milia is without erythema)

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2
Q

Sebaceous hyperplasia

A

related to maternal androgens causing increase in number of sebaceous cells (similar to neonatal acne)
regression occurs when hormone levels decline
often mistaken for milia

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3
Q

Neontal acne

A

does NOT put the child at risk for early puberty

due to maternal androgenic hormones (like sebaceous hyperplasia)
-causes sebaceous gland blockage —> comedones, pustules
-no scarring
presents around 2 weeks
resolves with decline in maternal hormones in 3-4 months
tx: self resolves
-can use soaps or benzoyl peroxide

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4
Q

Seborrheic dermatitis

A

caused by malassezia furfur
“Cradle cap”
presentation:
-yellow/pink greasy appearing scale on scalp and erythematous scaling on neck and face
-in older children/adults: often itchy, erythematous scaly rash on face

tx:
Ketoconazole 2% cream/shampoo 2x/week
OR
topical hydrocortisone 1% cream (if mostly erythematous)

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5
Q

What is the treatment for seborrheic dermatitis?

A

Ketoconazole 2% cream/shampoo 2x/week
OR
topical hydrocortisone 1% cream (if mostly erythematous)

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6
Q

Harlequin color change

A

transient well defined color change in neonates
hypothesized to be due to immaturity of autonomic nervous system causing transient vasodilation
benign
associated with prematurity, use of prostaglandin or certain types of anesthesia and even meningitis

can be confused with port wine stains (but harlequin is transient)

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7
Q

Mottling

A

otherwise known as “cutis marmorata”
appears as pink marble or “lacy” pattern, usually bilaterally, symmetrical

benign if transient
typically caused by capillary constriction in response to a cold trigger
occasionally can be congenital “cutin marmorata telangiectasia congenita” which is usually more severe, only on one extremity which is asymmetric in size to others

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8
Q

Livedo Reticularis

A

umbrella term for pink purple lacy pattern that is mottling

if related to cold –> cutis marmorata
if unresolved with warming –> can indicate shock or poor cardiac output

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9
Q

Erythema toxicum

A

unknown cause
appears in 50% newborns in 2-5 days of life –> spontaneously resolves

ddx: HSV, staph pustulosis
path: eosinophils

no treatment

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10
Q

What is the treatment for erythema toxicum?

A

none

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11
Q

Pustular Meanosis

A

vesicles with cloudy fluid (at birth) –> denuded, forming white crust –> hyperpigmented macules (within hours to few days)

cause unknown
path: neutrophils
benign

sometimes mistaken for HSV (difference is pustular melanosis lacks erythematous base, is less clustered, and less likely on a presenting part –presenting part like during labor and delivery (was the head first or butt, etc))

self resolves

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12
Q

Allergic contact dermatitis?

A

cause: exposure to irritant –> recruits pre-sensitized cutaneous T-cells to skin –> inflammation

tx:
avoid contact with irritant
keep skin surface dry
for diaper area, use emollients as barrier (zinc oxide cream, petrolatum)
hydrocortisone 1% or 2.5% ointment (for face; can use in severe diaper dermatitis)
mometasone (trunk/extremities)

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13
Q

Candidal diaper dermatitis

A

candidal (diaper) dermatitis

  • satellite lesions
  • beefy red
  • affects folds/creases

tx: topical nystatin

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14
Q

Contact diaper dermatitis

A

spares inguinal folds

rx: barrier cream
zinc oxide

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15
Q

Slate grey patch

A

mongolian spot

benign hyperpigmented (usually blue/back) patches, usually on sacrum but can be over back and extremities (usually not on face)

not associated with any condition

can be mistaken for ecchymoses, so document

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16
Q

Cafe au lait spot

A

benign hyperpigmented (usually brown) irregularly shaped macule or patch
found anywhere on body
if >6 spots, >5mm, it supports the likely dx of neurofibromatosis

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17
Q

Infantile hemangioma

A

vascular overgrowth due to dysregulation of endothelial stem cells
present at birth but grows rapidly throughout the first 6-12 months of life
then, it begins to spontaneously involute

tx: usually since they self resolve, its only a cosmetic issue
options tx are: propranolol (oral), steroids, and laser therapy

When to treat? (=when to worry)
if they are in a location where vision, breathing, or feeding can be affected
if they are very large (they can ulcerate and be prone to infeciton)
if they are midline over the sacrum along with a dimple (occult spinal dysraphism is more likely)

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18
Q

When should you be worried about hemangioma?

A

if they are in a location where vision, breathing, or feeding can be affected
if they are very large (they can ulcerate and be prone to infeciton)
if they are midline over the sacrum along with a dimple (occult spinal dysraphism is more likely)

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19
Q

What are you worried about for a child with hemangioma on the eyelid?

A

occludes vision, leading to amblyopia

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20
Q

Why are you worried about a child with hemangioma on sacral dimple or tuft of hair?

A

could indicate spinal dysraphism

obtain spinal US

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21
Q

If you are going to treat hemangioma, what is the treatment?

A 
usually since they self resolve, its only a cosmetic issue 
options tx are: 
propranolol (oral), 
steroids, 
laser therapy
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22
Q

Port Wine Stain

A

blanchable capillary malformation
usually are isolated lesions, but can be associated with genetic conditions (Sturge-Weber, Klipple-Trenaunay)

When to refer?
-if segments 1 and 2 of trigeminal nerve are affected (upper and lower eyelids):
its more likely to be associated with Sturge Weber sydnrome (if both the top and bottom eyelid are affected)
-if neurologic signs (seizures)
-can be associated with glaucoma

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23
Q

Congenital Melanocytic Nevus

A

rare tan-black color hamartomas made of melanocytes, present at birth
can be small, medium, large, or giant sized
ofentimes are irregularly shaped and have pilosebaceous glands (have hair)

when to refer:

  • large or giant 3-5% chance of melanoma –may require excision and grafting for cosmetic and oncologic purposes
  • small or medium: recommend routine monitoring by PMG and family for melanoma potential (1%) that occurs mostly after puberty
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24
Q

Measles (Rubeola)

A

caused by measles virus (a paramyxovirus)

epi: prior to vaccine in 1963, affected >500,000 people per year
declined to <500
spread by respiratory transmission
contagious for 4 days prior to rash onset and 4 days after the rash

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25
When is measles contagious?
contagious for 4 days prior to rash onset and 4 days after the rash
26
How does Measles present?
incubation period (10-12 days) -occurs after virus is spread to the respiratory mucosa prodrome (2-4 days) -high fever (103-105F), malaise -"cough, coryza, conjunctivitis" -enanthem: Koplik's spots (1-3mm grey/blue/white bumps on an erythematous base, usually in buccal and labial mucosa) Exanthem - (begins 2-4 days after fever) -erythematous maculopapular (initally blanching, then darkens and coalesces) rash beginning on forehead --> spreading down rash starts 2-4 days after fever onset. usually not pruritic -generalized lymphadenopathy; possible splenomegaly -fever lasts 2-4 days into rash, then self-resolves
27
What age do you get the measles vaccine?
12 months
28
Incubation period of measles
incubation period (10-12 days) -occurs after virus is spread to the respiratory mucosa prodrome (2-4 days)
29
Prodrome period of measles
prodrome (2-4 days) - high fever (103-105F), malaise - "cough, coryza, conjunctivitis" - enanthem: Koplik's spots (1-3mm grey/blue/white bumps on an erythematous base, usually in buccal and labial mucosa)
30
Koplik's spot
seen in prodrome of measles pts
31
Exanthem phase of measles
Exanthem - (begins 2-4 days after fever) -erythematous maculopapular (initally blanching, then darkens and coalesces) rash beginning on forehead --> spreading down rash starts 2-4 days after fever onset. usually NOT pruritic -generalized lymphadenopathy; possible splenomegaly -fever lasts 2-4 days into rash, then self-resolves
32
How do you dx measles?
a high level of suspicion consider in immunocompromised, under-immunized children with possible exposure appears "sick" testing: detecting measles RNA with RT-PCR positive measles IgM or rise in measles IgG during acute and convalescent stages if suspected: place child in airborne isolation room -call health department
33
What are the complications of measles?
secondary infections (PNA, diarrhea, encephalitis) SSPE (subacute sclerosing panencephalitis) -occurs 7-10 years after infection, progressive CNS degenerative disease
34
What is the treatment of measles?
supportive care ``` vitamin A (2 doses) for children -decreases mortality for children under 2 years ``` best treatment is prevention: vaccinate! (age 1 and 4 years)
35
Mumps
caused by mumps vius (a paramyxovirus) epid: prior to vaccine in 1967, was a common cause of encephalitis, orchitis, parotitis, and sensorineural hearing loss spread by respiratory droplets and direct contact
36
How to pts present with mumps?
nonspecific prodrom: fever, malaise, HA, myalgias | Parotitis: usually 48 hours after prodrome *not always present* can last up to 10 days
37
How do you dx mumps?
clinical dx: parotitis along with fever labs: elevated amylase, lymphopenia no lab tests are necessary in clear cut cases can do: mumps IgM increased mumps IgG titers between acute and convalescent stages PCR of mumps DNA
38
How can you tell parotitis from lymphadenitis?
if you can't see the angle of the jaw then it is most likely parotitis
39
What are the complications of mumps?
orchitis (unilateral painful inflammation and swelling of the testicle; can lead to impaired fertility) oopheritis sensorineural hearing loss (can be acute or gradual) encephalitis, aseptic meningitis
40
What is the treatment of mumps?
``` droplet precautions recommend isolation (At home) for at least 5 days after onset of sxs ``` supportive care vaccinate! (1 and 4 years,)
41
Rubella
caused by rubella virus (togavirus family) epi: spread by respiratory droplets
42
How do pts with rubella present?
these kids don't look sick (minus the obvious rash) low-grade fever and lymphadenopathy (posterior auricular or suboccipital) for 1-5 days rash appears from head and spreads down, faint pink maculopapules it resolves quickly (within 2 days) starting from the head down arthralgias and arthritis (occur in most adolescents and adults)
43
What is the Ddx of rubella?
``` roseola parvovirus enterovirus EBV measles associated with vaccine ```
44
How do you dx rubella?
rubella IgM or RT-PCR
45
What is the treatment for rubella?
supportive care, prevent with vaccine
46
What are the complications of rubella?
encephalitis (rare) | risk of congenital rubella syndrome is pregnant pts are exposed
47
Congenital rubella syndrome
toRch infection causing significant disease in fetus if acquired in the 1st trimester in 3rd trimester, only causes IUGR (growth restriction) presentation (if 1st trimester acquisition): cataracts, cardiac defects, deafness heaptosplenomegaly, jaundice, "blueberry muffin lesions" (purpura), microcephaly, and sometimes meningoencephalitis
48
How do you dx congenital rubella syndrome?
obtain pregnancy hx rubella IgM, PCR, or persistent IgG consider other TORCH infections (CMV - can present with blueberry muffin baby)
49
What is the treatment for congenital rubella syndrome?
due to 20$ mortality, should transfer to a NCIU setting for comprehensive evaluation no disease specific treatment
50
Blueberry muffin baby
congenital rubella syndrome typically the classical presentation is cataracts, cardiac defects, deafness
51
"Fifth Disease"
erythema infectiousum caused by parvovirus B19 epi: spread by respiratory droplets more common in the young (up to 60% of adults have IgG evidence of prior infection)
52
How to pts with erythema infectiousum present?
"slapped cheeks" prodrome of fever, malaise, HA erythematous, vonfluent plaques on malar face - slapped cheeks - appear first and fade over 1-4 days Body rash appears after facial lesions erythematous macules and papules become confluent giving lacy or reticular appearance best seen on extensor arms; also trunk and neck rash fades after 5-9 days, but reticular rash may recur for weeks - months arthralgias in 10% of cases more common in adolescents and adults
53
How do you dx fifth disease?
erythema infectiosum (parvovirus) usually clinical - can confirm with: Parvovirus B19 by PCR demonstration of IgM parvovirus B19 antibodies IgG seroconversion
54
What are the complications of erythema infectiosum?
``` aplastic crisis (typically for children who already have problems with their RBCs) -due to infection of RBC precursors in pts with underlying hemolytic anemia (presents as reticulocytopenia, worsening anemia, +/- transfusion requirement) ``` hydrops fetalis
55
What is the treatment for parvovirus?
(aka fifth disease, aka erythema infectiosum) supportive care
56
Sixth disease
roseola infantum caused by human herpesvirus - 6 (HHV-6) usually occurs in children <2 year spread by secretions to close contacts super high fever --one of the reasons for febrile seizures in kids the fever breaks and then BAM -rash
57
How to pts with roseola infantum present?
sixth disease 3-5 days of high fever (>40C) fever subsides, then... rash (blanching pink, maculopapular) starting on the neck/trunk --> spreading to the face and extremities
58
What is the treatment of roseola infantum?
supportive care just reassure the parents that this is a virus, it will pass
59
Eczema herpeticum
infection cased by HSV-1 usually occurs in children with atopic dermatitis or other skin conditions, or in immunocompromised people medical "urgency"
60
How do pts with eczema herpeticum present?
acute onset fever with rapid PAINFUL eruption of "punched out" pustular/vesicular lesions may be difficult to distinguish from baseline eczema if poorly controlled may also have swelling and erythema which can indicate bacterial superinfection medical "urgency"
61
How can you counsel a family in regards to febrile seizures?
don't worry if it lasts less than 5-10 minutes (time it) dont worry if its generalized worry if it lasts longer than 15 minutes worry if they have had more than 1 in 24 hours worry if its a focal seizure
62
What are the risks of eczema herpeticum?
sig morbidity and mortality secondary to bacterial superinfection
63
What is the treatment for eczema herpeticum?
medically "urgency" ``` PO acyclovir (unless ill appearing or immunocompromised, may use IV) while awaiting HSV confirmatory testing concurrent anti Staph ABX +/- IVFs (clinda) ```
64
Varicella Zoster
caused by varicella zoster virus (VZV), a hepresvirus epi: highly contagious; spread by airborne particles incubation 10-21 days prior to onset of rash "dewdrops on a rose petal" appearance
65
How do pts with varicella zoster present?
malaise, low grade fever precede rash by 1 day pruritic crops of macules that turn into vesicles on an erythemaotous base "dewdrops on a rose petal" that crust over within hours to days new crops appear for 3-4 days resulting in vesicle in different stages of healing start on trunk, then head and face, then extremities pruritus is marked
66
What are the complications of varicella zoster?
bacterial superinfection PNA primary varicella can be fatal in immunocompromised (mortality approaches 15% in children with leukemia who do not receive prophylaxis or therapy)
67
How do you dx varicella?
clinically | or by scraping base of vesicle for PCR or DFA exam
68
What is the treatment for varicella zoster?
place in airborne isolation room if suspected and have pregnant caregivers avoid contact PO acyclovir or valcyclovir for children >12 yo or immunocompromised supportive care - NO APSIRIN - oatmeal baths - careful hygeine
69
Shingles
herpes zoster caused by reactivation of varicella zoster virus (VZR) in the sensory ganglia of the nerve presentation: initial tingling --> painful dermatomal distribution of erythematous vesicular lesion
70
What are the complications of shingles?
if anywhere on the face (trigeminal distribution), could indicate ocular involvement *treat aggressively
71
What is the treatment for shingles?
topical antipurutitics, PO analgesics acyclovir only in cases affecting trigeminal nerve, immunocompromised, or >12 y/o
72
Molluscum contagiosum
caused by molluscum contagiousum virus, a poxvirus epi: occurs in healthy children and immunocompromised adults spread by skin contact (sports, sexually transmitted)
73
What is the presentation of molluscum contagiousm?
flesh colored umbilicated, fluid filed pusutules occurs anywhere on the body EXCEPT palms/soles
74
What is the treatment for molluscum contagiosum?
self limiting reassure parents that it's benign cryotherapy (with liquid nitrogen) curettage cantharidin (blistering agent)
75
SSSS
staphylococcal scalded skin syndrome caused by: toxin produced by staph aureus that is hematogenously spread ot skin, causing blistering presentation: do NOT affect mucosal surfaces usually children <5y/o fever and skin with generalized erythema and initial flaccid bullae usually in the skin fold --> bullae rupture and create area of erosion
76
How do you tell the difference between SSSS from SJS?
SJS affects multiple mucosal surfaces
77
How do you treat SSSS?
Nafcillin Clindamycin Vancomycin
78
Neisseria meningitis
MC cause of bacterial meningitis in children - 13% mortality higher rates in areas of crowding
79
How do pts with neisseria meningitis present?
rapid onset of fever, HA, vomiting, intense myalgias (leg pains are often worse than viral myositis) petechial/purpuric rash (does NOT blanch) often on trunk/extremities progress quickly to altered mental status, shock, and IDC
80
How do you treat neisseria meningitis?
early dx is key blood, CSF, and coags should be evaluated IV ABX (IV ceftriaxone) x 7 days ABX should not be delayed >30 minutes to obtain CSF studies
81
Lyme disease
Borellia burgdorferi spread by tick bite presentation: (you can start at any stage) early localized: erythema migrans - spreading erythemaotus target like rash from the site of the tick bite, occurs 7-14 days after bite early disseminated: multiple erythema migrans neurological sx: HA, Bell's palsy (bilateral is almost always Lyme), meningitis, encephalitis cardiac sx: carditis (complete heart block) nonspecific sx: fever, maliaise, myalgia late: arthritis (affected 1 or few large joints, usually knee)
82
What is the treatment of lyme disease?
``` Erythema migrans (early logalized) Doxycycline )if >8y.o) or amoxicillin (<8y/o) PO x 10-21 days ``` ``` early disseminated (neuro, cardiac) facial nerve palsy: doxyclycine or amoxicllin PO x 14-21 days Meningitis: IV Ceftriazone 21-28 days ``` Late disease (arthritis): Doxycycline PO x 28 days (if not neuro disease) IV ceftriaxone x 28 days (if some neuro disease) basically for <8y/o Amoxicillin PO if early disease or IV ceftriaxone if severe for >8y/o doxy
83
Fever defined
>/= 38C (100.4F)
84
Hyperthermia from fever, tissue damage?
no evidence for tissue damage (brain injury) until sustained temperatures between 41-42C
85
When can you transition from rectal to oral thermometers in children?
rectal from birth - 3 years | oral 4+ years
86
What education can you provide a parent in regards to fever in their child?
recognize that fever itself is unlikely to be harmful beneficial in fighting infection treat fever only if improve childs comfort
87
How do you treat fever in a child?
Acetaminophen -15mg/kg every 4-6 hours PO, PR (Max 90mg/kg q 24 hrs) pay attention to formulation and strength when dosing dont use Ibuprofen in children <6 months 10mg/kg q 6-8 hours (Max 40mg/kg q 24 hours) risk of nephrotoxicity with dehydration
88
Infants <28 days old with a fever
most fevers caused by viral illness most common bacteria: GBS, E.Coli, listeria HIGHEST risk group for invasive bacterial infection (IBI - bacteremia, meningitis)
89
Infants 29-90 days old with fever
still high risk for IBI
90
What do you do for all children un 3 months with a fever?
``` any febrile infant <3 months of age who appears ill and ALL febrile infants <28 days of age should: be admitted to the hospital get a work up: -blood, urine, CSF for culture -chest X-ray if resp sxs -stool studies if diarrhea -consider HSV in febrile infants <4 weeks of age Be treated with broad spectrum IV ABX ```
91
When do you get blood and urine cultures in children <3 years?
if they have a fever and no source UTI is MC cause occult bacteremia less common since HIB and prevnar vaccines

Peds Exam 2 (11 decks)

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