Paeds Flashcards
1
Q
exanthem
A
a widespread rash occurring on the outside of the body and usually occurring in children
2
Q
whats usually used to Rx Neonatal withdrawal (abstinence) syndrome
A
morphine sulphate
3
Q
what are the classification groups of Paediatric Dermatological Conditions
A
infective infestations inflammatory genetic neoplastic
4
Q
Primary Skin lesions
A
These are fundamental morphological changes that appear first on formerly unchanged skin
5
Q
eg of Primary Skin lesions
A
Macule vesicle Papule Plaque Nodule
6
Q
Secondary Skin Lesions
A
lesions that develop from the alteration of primary lesions not on uninvolved skin
7
Q
eg of Secondary Skin Lesions
A
Scale Keratosis Fissure Erosion Excoriation
8
Q
Macule
A
Circumscribed, flat area of skin different in colour or texture from the surrounding, normal skin
A macule does not exceed 1 cm in greatest diameter
9
Q
patch
A
A large macule more than 1cm in diameter
10
Q
cx of macules and patches
A
Deposition of endogenous (hemosiderin) or exogenous products (tatooing)
Extravasation of blood (petechiae, purpura, ecchymoses, hematoma)
Changes in melanin content of the epidermis or dermis ( hyper- and hypopigmentation or depigmentation, melanoderma and leukoderma)
Active erythaema and passive hyperaemia (cyanosis)
Deminished blood supply and vasoconstriction
11
Q
what other features can macules and patches have
A
may be slightly depressed below the skin surface or
scaling
12
Q
papule
A
A circumscribed solid elevation of the skin up to 1 cm in diameter
13
Q
cx of papule
A
tissue proliferation
cell infiltration
14
Q
types of papules
A
epidermal
dermal
Dermoepidermal
15
Q
plaque
A
A circumscribed, superficial, solid elevation of the skin greater than 1 cm in diameter
16
Q
do Plaques occur as secondary lesions
A
Plaques may occur as primary lesions but may also result from coalescence of papules and then strictly speaking represent secondary lesions.
17
Q
nodule
A
A circumscribed solid lesion of the skin up to 1 cm in size with depth
18
Q
diff btwn nodule and papule
A
nodules can always be palpated and have depth
19
Q
tumour
A
A solid lesion of the skin greater than 1 cm in diameter with superficial height, palpable depth or both
20
Q
how do Tumours differ from papules and nodules
A
by size
may be inflammatory or non-inflammatory
benign or malignant
21
Q
wheal
A
Transient dermal oedema, varied in size disappearing within up to 24 hours and typically cause itching
22
Q
what colours can wheals become
A
pale red if the capillaries are dilated
whitish if the dermal oedema is heavy enough to compress the blood vessels
23
Q
vesicle (small blister)
A
a circumscribed elevation of the skin up to 1 cm in diameter and containing fluid
24
Q
BULLA (large blister)
A
a circumscribed elevation of the skin greater than 1 cm in diameter containing a fluid
25
Types of vesicles and bullae
subcorneal
Intraepidermal
Subepidermal
dermal
26
what fluids may blisters may house
serum, blood, lymph or a mixture of these fluids
27
pustules
A circumscribed superficial elevation of the skin filled with pus
28
name the 9 Morphological characteristics of skin conditions
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size
shape
colour
number
arrangement
```
margins
consistency
surface characteristics
contour
29
give 5 eg of shape
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guttate (drop shaped)
nummular (coin shaped)
annular (ring-like)
serpiginous (wavy, snake-like)
arcuate (arc-like)
```
30
Koebner phenomenon (isomorphic response)
an aspect of psoriasis that’s well-known but not completely understood. It describes the formation of psoriatic skin lesions on parts of the body that aren’t typically where a person with psoriasis experiences lesions
31
Psoriasis
a skin disorder that causes skin cells to multiply up to 10 times faster than normal. This makes the skin build up into bumpy red patches covered with white scales
32
psoriasis appears mostly on
scalp, elbows, knees, and lower back
33
nikolski
When exerting tangential pressure on apparently normal skin, particularly near vesicles, the epidermis or parts of it may be detached in certain bullous diseases eg toxic epidermal necrolysis or epidermolysis bullosa
34
dermographism/
| dermatographism
exaggerated wealing tendency when the skin is stroked
| A bright red non-raised line due to vasodilatation occurs after 3-15 seconds
35
what happens to Dermographism In patients with atopic dermatitis
the respons is para-doxically anaemic (white dermographism)
36
wha is dermographism the commonest form of
physical or chronic inducible urticaria
37
cutis marmorata
transient, benign, reticulate, mottled, bluish discolouration of the skin that may last minutes to hours typically when child is cold, usually completely disappears by two months of age
38
if Cutis marmorata is persistent what syndromes can it indicate
Cornelia de Lange syndrome
trisomy 13
trisomy 18
39
what is Cornelia de Lange syndrome characterized by
slow growth before and after birth
intellectual disability
abnormalities of bones in the arms, hands, and fingers
40
skin fragility
Weakened attachments be-tween epidermis & dermis that are easily severed by physical or chemical trauma
41
peeling skin
Desquamation of neonatal skin most pronounced in infants born 40-42 weeks gestation
Rx an aqueos cream is used No creams with perfume or additives
42
types of peeling and where they occur
Physiological peeling – hands, ankles and feet
| Postmature peeling – extremities and trunk
43
epsteins pearls
Benign Epidermal inclusion cysts (contain desquamated keratin) occur along the median palatal raphe, most commonly at the junction of the hard & soft palate.
44
what other skin lesion is similar to epstein pearls
milia
45
milia
Tiny (1-2mm) globular epidermal inclusion cysts which are white, pearly & firm
Occur on the nose, cheeks, chin and foreheads and usually appear and disappear spontaneously during first month of life
46
where can Larger milia solitary lesions can be seen on
foreskin, scrotum, areolae and labia majora.
47
diff btwn pustule and milia
Pustule - more yellow
| Milia – more white
48
Sucking calluses
solitary, oval thickenings on vermilion on the lips and is more common in breast fed, black infants.
Sucking calluses involute spontaneously within a few days to weeks after birth or upon cessation of breastfeeding
49
Sebaceous Gland Hyperplasia
Multiple, pinpoint, yellowish papules seen at the opening of each pilo-sebaceous follicle in areas where sebaceous glands are abundant, such as the nose that resolve spontaneously.
50
Sebaceous Gland Hyperplasia Rx
you can use vaseline or an aqueous cream but the latter is preferred
51
neonatal mastitis
Maternal and placental hormonal effects on the neonate
| Secretion of colostrum like substance called “witches milk” late during first week of life
52
Mongolian Spots
Brownish, blue-gray or blue-black patch usually located over the sacro-gluteal area
Most common of all birthmarks in pigmented races
53
erythema toxicum facts
Common in term infants (not preterms)
Appear birth to 2 weeks
Erythematous macules, papules, pustules or wheals found on any body surface
Palms and soles rarely affected
Dissapears spontaneously (The rash usually clears within 2 weeks. It is usually completely gone by age 4 months)
54
Transient Neonatal Pustular Melanosis
Benign condition
Term neonates
Present at birth and resolve within 48 hours
After healing – end up with freckles
Lesions include
vesicles, pustules, crusted lesions, ruptured pustules with scale & pigmented macules –singly or in combination
55
Miliaria
obstructions of the eccrine duct resulting in rupture of the ducts and sweating into the skin
Fragile 1-2mm clear, non-inflammatory vesicles
Most common in 1st week of life
56
miliaria types
Miliaria crystalline
Miliaria rubra
Miliaria profunda
Miliaria pustulosa
57
Miliaria Rubra
secondary local inflammatory response is responsible for the erythema associated with the papules and vesicles
Common sites face neck and trunk
58
Neonatal acne/Transient Neonatal Cephalic Pustulosis
Common on face, neck, chest & back
| Resolves within first 6 months of life
59
Epidermolysis Bullosa
Neonatal vesicles, bullae and denuded skin, with friction and trauma induced blistering
can cx bleeding and Skin infections
Give morphine
60
Subtypes of Epidermolysis Bullosa
Simplex
Junctional
Dystrophic
61
Subcutaneous Fat Necrosis facts
```
Idiopathic necrosis of the panniculus (subcutaneous fat) Indurated (hardened) plaques or nodules below the skin
can become hypocalcaemic
self limiting – week or two
ass with trauma during labour
term babies
```
62
aphtha
small ulcer of mucous membranes
63
cyst
any closed cavity with an epidermal, endothelial or membranous lining containing fluid or soft material
64
erythroderma
generalized redness associated with infiltra-tion and disquamation of the skin
65
Gangrene
necrotizing process due to arterial occlusion or infection
66
Lichenification
thickening of the skin with accentuation and coarsening of the skin markings
67
milium
tiny white cyst containing keratin
68
scab
devitalized portion of the skin due to necrosis
69
impetigo
Round confluent superficial blisters which rupture early and form crusts
70
impetgo
Round confluent superficial blisters which rupture early and form crusts
71
erysipelas
Superficial form of cellulitis involving the dermis and upper subcutaneous tissue
72
Staphylococcal Scalded Skin Syndrome
Cutaneous tenderness and superficial widespread blistering & desquamation
73
Pityriasis Rosea
Acute self limited, papulo-squamous disorder. Rash is often preceded by a herald patch with collarette of scale
74
herald patch
erythematous, scaly 2 to 10 centimeter, round to oval patch or plaque with a depressed center and raised border.
75
Erythema Multiforme Simplex
Acute self-limiting (1-2 weeks) vesicobullous disease with erythematous macules and papules which evolve into “target” lesions
ass with HSV
76
Stevens-Johnson syndrome
Sudden onset of tender erythematous eruption usually due to a reaction to a medication or an infection
77
Stevens-Johnson syndrome cx
Antibiotics
Anticonvulsants
NSAIDS
Mycoplasma pneumoniae
78
Toxic Epidermal Necrolysis
like sjs but faster onset more severe but less common
| Early symptoms include fever and flu-like symptoms
79
Erythema Nodosum
Abrupt onset of tender red subcutaneous nodules on extensor surfaces of lower legs
80
Scabies
the release of toxic or antigenic secretions of the female mite Sarcoptes scabiei var hominis
81
Scabies
the release of toxic or antigenic secretions of the female mite Sarcoptes scabiei var hominis
small 1-2mm itching papules with various degrees of crusting and scaling
82
scabies Most common sites
Hands, palms, wrists, buttocks, feet
83
Scabies extra facts
Females lay ± 3 eggs/day, requiring ± 4 days to hatch
Time from egg laying to adult mite is 10–14 days
Mites are not blood feeders, but are thought to feed on intercellular fluid
can be acute or chronic (Acute glomerulo-nephritis if infected with Group A Streptococcus)
84
scabies Rx
Lindane or Quellada lotion (Gamma Benzene hexachloride 1%)
sulphur 2,5%
Tetmosol soap
Benzyl benzoate
Permethrin with 70-80% of ovicidal activity
85
Cutaneous Larva Migrans (Sandworm)
A creeping erruption caused by Ancylostoma braziliense crawling btwn epidermis and dermis
cx intense pruritis, erythaematous, raised, serpigenous tracts
86
Cutaneous Larva Migrans (Sandworm) extra facts
secondary infx is common
Topical thiabendazole 10-15%
Albendazole
87
Major pathogens causing superficial fungal infections in children
Dermatophytes: Trichophyton
Microsporum
Epidermophyton
Yeasts: Candida
Malassezia
88
Tinea corporis
Active circumscribed raised round or oval scaly margins which spread outwards
89
Tinea corporis Rx
Imidazoles
| Griseofulvin
90
Pityriasis Versicolor
Caused by malassezia yeast
| Lesions on the face are usually hypopigmented, faintly scaling & ovoid
91
Pityriasis Versicolor Rx
fluconazole
| ketoconazole
92
Scaling skin
the loss of the outer layer of the epidermis in large, scale-like flakes
93
Pediculosis Capitis facts
human head louse that Infests the scalp and sucks blood
Pruritis is common in long term infestation, but first time infestation may produce no symptoms whatsoever
nits adhering to the hair
94
Pediculosis Capitis EXTRA FACTS
Infestation most common in children 3-11 yrs
More common in girls than boys
Likes CLEANLINESS – hair but on body – LIKES DIRT
Most head lice products kill the adult lice but not the nits. Thus all topical treatments should be applied twice, 1 week apart
95
Pediculosis Capitis Rx
Gamma benzene hexachloride
Permethrin
Nitagon
96
lymphadenopathy common causes
infections
autoimmune diseases
cancers
97
medications that cause lymphadenopathy
```
Allopurinol
Atenolol
Captopril
penicillin
Quinidine (anti arrythmic)
```
98
Epidemiologic Clues to the Diagnosis of Lymphadenopathy
Cat scratch - Cat-scratch disease, toxoplasmosis
Undercooked meat -Toxoplasmosis
Tick bite - Lyme disease, tularemia
99
Pain in LN is usually the result of an inflammatory process or suppuration, but pain may also result from
hemorrhage into the necrotic center of a malignant node
100
LN Consistency.
Stony-hard nodes are typically a sign of cancer, usually metastatic
Very firm, rubbery nodes suggest lymphoma. Softer nodes are the result of infections or inflammatory conditions
Suppurant nodes may be fluctuant
101
dx which cx benign matted LN
TB
sarcoidosis
lymphogranuloma venereum
102
where do cat scratch dz and infectious mononucleosis cause lymphadenopathy
Cat SD- cervical or axillary adenopathy
| Infx M- cervical
103
Diff diagnosis of lymphadenopathy in Mononucleosis-type syndromes, EBV, leukemia, serum sickness
Mononucleosis-type syndromes: fever, malaise, Fatigue, atypical lymphocytosis
EBV type: Splenomegaly in 50% of patients
Leukemia: Blood dyscrasias, bruising Blood smear, bone marrow
Serum sickness: Fever, malaise, arthralgia, urticaria
104
Increased hydrostatic pressure cx
High venous pressure - Congestive cardiac failure
- Constrictive pericarditis
Sodium and fluid retention -Glomerulonephritis
-Acute renal failure
105
Decreased oncotic pressure cx
Decreased protein intake
Impaired absorption
Impaired production
Protein loss
106
besides Increased hydrostatic pressure
| Decreased oncotic pressure what cx oedema
Impaired capillary permeability
| • Sepsis/inflammation
107
Microcytic RBCs cx
Iron deficiency
Sickle-cell disease
Thalassemia
108
Iron deficiency presentations and Rx
Tired
Koilonychias
Splenomegaly
Rx: ferrous gluconate/sulphate @ 6 mg/kg elemental iron
109
Thalassaemia facts
Hb rarely < 10g/dl
S Iron normal
HB A2 & HB F increased.
110
Sickle cell disease facts
Splenomegaly
Hb S & Hb F Increased
Hb A decreased
