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PNCB Prep: Dermatologic/Integumentary/Infectious Disease
Terms in this set (133)
Transient mottling of the neonate's skin with a generalized lacy, reddish-blue appearance.
Caused by uneven blood flow and exposure to cold.
No treatment necessary.
Erythema Toxicum Neonatorum
Yellow-white lesions of varying morphology that arise from an erythematous reddish-pink base; barely elevated yellowish papules often found on the trunk. NOT on palms and soles
Erythema Toxicum Neonatorum location
appears first on the face and spred to the trunk and extremities, but may appear anywhere on the body
Erythema Toxicum Neonatorum resolves
fade over 5-7 days
Erythema Toxicum Neonatorum onset
onset 24-48hrs of life
Erythema Toxicum Neonatorum tests
wrights stained smear of pustules, shows eosinophils
Small yellow-white papular inclusion cysts filled with cheesy keratinous material predominantly on face (cheeks, forehead and nose)
No treatment necessary; condition resolves spontaneously
Salmon Patch (Nevus Simplex)
Benign, flat, light red to orange vascular birthmark on head and face.
Fades with time; no treatment necessary.
Port-Wine Stain (nevus flammeus)
Benign, permanent, flat, dark red to purple vascular lesion, predominantly on head and face.
Does NOT fade with age.
If a port-wine stain lesion covers entire half of face or bilateral, it may be associated with which condition?
Capillary Hemangioma (Strawberry Nevus)
Bright red or blue-red nodular tumor of varying sizes and shapes with rubbery and rough surface, found predominantly on the head/face
A patient with 6 or more cafe au lait spots larger than 1.5cm should be evaluated for which associated neurological condition?
Blue-black and gray macular lesions of irregular shape and varying sizes; usually on sacrococcygeal region, buttocks and lumbar areas.
Most fade completely during childhood/adolescence; no treatment necessary
J.D. is a postterm infant with lesions of varying morphology, including wheals, vesicles, and pustules on her trunk. You suspect:
Erythema toxicum neonatorum
In order to confirm a diagnosis of erythema toxicum neonatorum, you order a Wright's stained smear. If the diagnosis is correct, what are the expected results of the smear?
Presence of eosinophils
What is the best management for erythema toxicum neonatorum?
No treatment necessary; the condition will resolve spontaneously on its own in 5 to 7 days
You observe numerous white papular lesions on the cheeks, forehead, and nose. You suspect milia or neonatal acne. Which physical finding helps to confirm a diagnosis of milia?
Papular lesions, yellow in color observed on the hard palate.
You observe a child with a flat, dark red vascular lesion on the face that does not fade with age. What is your diagnosis?
Port-wine stain (nevus flammeus)
An 8yo boy has pruritic, scaly, hyperpigmented lesions in a "fir tree" distribution, predominantly on his trunk. One lesion on the buttocks is larger than all the other lesions and measures 4cm in diameter. What is your likely diagnosis?
What is the most common symptom of pityriasis rosea?
For the patient with atopic dermatitis with a secondary bacterial infection at the site of several lesions, what is the best management for the infection?
You see a 6 week old with a bright red, raised, rubbery lesion of irregular shape and 2cm in diameter on the occiput. What condition do you suspect B.D. has?
You observe 10 macular tan lesions of varying sizes on a patient and refer him for a medical evaluation to rule out neurofibromatosis or Albright syndrome. What kind of lesion does the patient have?
Cafe au lait spots
What is the treatment of choice for pityriasis alba?
Bland moisturizers to reduce overdrying
Patient education regarding prevention of malignant melanoma is essential. What is considered the best prevention education?
- Avoid sun tanning lamps
- Use cover-up clothing, hats, and sunglasses
- Use sunblocks that protect against ultraviolet exposure with SPF 30
What symptoms is most characteristic of contact dermatitis?
Pruritis at the site of affected areas
What is the best treatment of seborrhea in the infant?
Mineral oil to loosen crusts prior to washing affected areas with nonperfumed baby shampoo.
You are evaluating a 3yo who sustained acute burns when she pulled a pan of boiling water onto herself within the past hour. How would you rate the burn if 5% of her body surface is burned and the burned area involves the epidermis and upper part of the dermis?
She has major first- and second-degree burns
What is the best treatment for major first- and second-degree burns?
Refer for urgent treatment in an ED
What is the most common cause of folliculitis?
Folliculitis most commonly occurs on which body surface?
Neck and scalp
What treatment is prescribed for folliculitis caused by S. aureus?
A 12yo has several vesicles and honey-colored crusted lesions on her face above the right nares. She has a history of having had a scratch in the same area several days ago. What condition is suspected?
What are the choices of oral antibiotics for moderate acne?
Tetracycline, doxycycline, or minocycline
A 13yo has several firm, small (2mm) white or skin-colored umbilicated papules on her neck. The lesions have been present for 3 months and have increased in number. What is your diagnosis?
What is the cause of molluscum contagiosum?
A 7yo is complaining of pain and burning on his right leg, where you observe two small red puncture marks surrounded by a blanched area with an erythematous border. He had been playing with his dog all morning outside in a grassy wooded area near his home and was wearing shorts. You suspect he has been bitten by which insect?
Black widow spider
What is the most important confirming evidence for making a diagnosis of erythema multiforme major (Stevens-Johnson Syndrome)?
Occurrence of prodromal systemic symptoms of fever, malaise, sore throat, headache, nausea, and/or vomiting with development of multimorphologic rash that progresses to papules, vesicles, erosions and petechiae.
What is the typical morphology of lesions often seen in urticaria, a hypersensitivity allergic reaction?
A 7yo, female presents with several hyperkeratotic raised, periungual lesions on the two middle fingers of her left hand. She has a history of nail biting. What is the most likely diagnosis?
Common Verruca vulgaris (Warts)
In infants, the lesions associated with atopic dermatitis are most like to be distributed on the:
Cheeks and forehead
During your newborn examination, you note a generalized lacy reticulated blue discoloration. This clinical presentation describes:
A 7 month old presents with a beefy red macular-papular rash in the diaper area with satellite lesions on the abdomen. You suspect candida albicans. What is the appropriate treatment?
What testing is done to obtain a definitive diagnosis of scabies?
Microscopic skin scraping - scrapings of burrows will reveal the mite, eggs, or feces if scabies are present
What is the treatment of choice for scabies?
Topical Permethrin 5%
What should be done with nonwashable items that have come into contact with a patient with pediculosis capitis?
Nonwashable items that have come into contact with an infected person should be sealed in plastic bags for 2 to 4 weeks
You observe an infant with beefy red macular-papular and scaly plaques on their diaper area with satellite lesions on the abdomen. The presence of satellite lesions on their abdomen indicates:
Characteristics of mild acne:
Open and closed comedones and occasional pustules
Characteristics of moderate acne:
Open and closed comedones, papules, and pustules
Characteristics of severe acne:
Open and closed comedones, papules, pustules and cysts
A 4yo presents with a depigmented macular lesion on his forehead with sharp borders; no scales are present. What is the most likely diagnosis and treatment?
Tx: 1% Hydrocortisone
A 7yo presents with three small patches of hair loss on his scalp. Broken hair is present with "black dot appearance", erythema and scaly patches. What is the likely diagnosis?
What is the difference between psoriasis vulgaris and psoriasis guttate?
Psoriasis vulgaris - large (5-10cm) plaques with thick silvery scales located on the elbows and knees
Psoriasis guttate - small (3-10mm) multiple tear drop, round or oval papules/patches that become covered by a silvery-gray-white scale on trunk and proximal extremities
The "itch that rashes"
Atopic dermatitis (Eczema)
Chronic eczema is characterized by:
Hyperpigmentation, leathery, and lichenified in the flexor surfaces of the neck, antecubital areas, wrists, popliteal area, ankle, fingers and toes
What is the most common metal that causes contact dermatitis?
Nickel (often in jewelry, clothing snaps, and belt buckles)
Monilial rash associated with diaper dermatitis is caused by:
Proven factors contributing to acne include:
- Increased androgenic hormonal influence
- Positive family history
UNPROVEN factors related to acne:
- Poor hygiene
What measures should be taken for females taking Isotretinoin for severe acne?
- Contraindicated in pregnancy; teratogenic
- If sexually active, birth control measures are required
- Federally mandated enrollment in iPLEDGE program requires informed, signed consent, monthly laboratory studies and monthly office visits
What is the most common cause of a common cold sore/fever blister?
Herpes simplex - type 1
Common infectious, self-limiting condition characterized by waxy, firm pink-white or skin colored umbilicated/dimpled papules:
What is the treatment of choice for Tinea fungal infections that are unresponsive to topical antifungals?
Oral antifungal (GRISEOFULVIN)
Patient presents with mildly itchy, slightly raised round scaly areas with pink borders on the trunk. What is the likely diagnosis?
Tinea corporis (ringworm of the body)
What diagnostic testing confirms Tinea fungal infections?
Dermatophyte test medium (DTM)
Scabies is caused by:
Sarcoptes scabiei (itch mite)
What is the most common complaint in a patient with scabies?
Intense pruritis/itching, especially at night
A patient presents with red bumps, blisters, pustules, small burrow marks, scratch marks and complains of intense itching, particularly at night. You should suspect:
Management of environment for the patient with diagnosed scabies infestation:
- Treat household and other close contacts
- Wash clothes, bed linens, towels, and hats with hot water and dry in a hot dryer
- Store nonwashable items in plastic bags for 1 week; do not use
An allergic reaction/hypersensitivity to a drug is often predominantly characterized by:
A morbilliform generalized rash; measles-like rash (red macular lesions)
Begins on trunk and progresses to extremities with intense generalized and localized pruritis
Hypersensitivity reactions to drugs are caused by:
A release of histamine in reaction to immune response to drug allergen
What are the most common drugs that induce hypersensitivity reactions?
What type of hair is darkly pigmented and found primarily on the scalp and face of males?
Management of hypersensitivity reaction to drug:
- Discontinue contact with drug/medication if known sensitivity
- Oral steroids to reduce inflammation and immune response (Prednisone)
- Oral antihistamines for nocturnal pruritis
A 3yo boy was brought into the clinic because his mother noticed a very distinct erythematous area with a defined border on his waisteline. The area was slightly indurated but intact. which factor would be key in your assessment?
Use of a belt (related to nickel allergy/contact dermatitis)
A 2yo with a history of asthma and nasal allergies arrives for her 2yo well visit and upon examination, you notice a dry scaly patch on the inner aspect of her elbows. What do you suspect?
Eczema (Atopic dermatitis)
KOH preparation provides a rapid and reliable method for evaluating fungal elements; once added to the specimen, it is heated over an alcohol lamp. This is called a .......
What is the normal angle of a nail?
Capillary refill should occur within how many seconds?
Which term refers to a configuration of a skin lesion that is arc-shaped?
Linear crack from epidermis into dermis
Characteristics of vesicles:
Raised, fluid-filled lesions less than 1cm such as blisters or herpes simplex
Which ethnicity has a bluish tinge of the lips?
At what age is the average onset of acne?
12 years of age
At what age should a health care provider begin to discuss sun exposure with parents?
A 14yo African American girl comes in for a physical examination. During her exam, thickening and darkening of the axillae are noted. What might this assessment finding indicate?
Insulin resistance and type 2 diabetes
First-line therapy for all forms of acne include:
A retinoid product and topical antimicrobial
A 4yo child presents to the clinic with a fever of 101F; anorexia; fussiness; and vesicles on the buccal membranes, tongue, palms, and soles. What is the most likely diagnosis?
Hand, foot and mouth disease
What is considered first line treatment for pediculosis capitis?
Permethrin (Nix) Cream rinse
A 17yo female presents with a rash on her trunk that is scaly macular-papular with some pruritis; there are no lesions on the mucous membranes, palms or soles. There is one round lesion that is much larger (3cm) than the rest of the rash. It is salmon-colored with an erythematous border and appeared first. There have been no other signs of illness. The most likely diagnosis is:
- The clinical presentation includes classic description of pityriasis rosea with Herald patch
What medication is indicated for the treatment of pityriasis versicolor (tinea versicolor)?
Selenium sulfide 2.5% lotion (Selsun)
What is the most appropriate intervention for the patient with Rocky Mountain Spotted fever?
Begin antibiotics immediately (Doxycycline)
What education should be provided to the patient taking griseofulvin for tinea capitis?
Take griseofulvin with whole milk or ice cream.
- High fat foods enhance absorption of griseofulvin
What is the primary symptom of atopic dermatitis?
Pruritis; "the itch that rashes"
Which population is most susceptible to sepsis?
- Because of their immature immune system
What criteria define systemic inflammatory response syndrome (SIRS)?
i. Abnormal temperature (>38.5C or <36) and Tachycardia
ii. Leukocyte count (Elevated or Depressed) and Tachycardia
What are the most common causes of Sepsis?
- Hospital-acquired bacterial infections
(coagulase-negative staph infections most common)
What is the leading cause of morbidity and morality among hospitalized patients?
What are the complications of untreated sepsis?
- septic shock
What is the most common source of infection in children with sepsis?
What are common clinical manifestations of Diphtheria?
Gray and white tonsillar exudate
Chronic, nonhealing sores or shallow ulcers with dirty gray membrane
Pertussis is characterized by:
Prolonged coughing episodes ending in an INSPIRATORY "whoop"; paroxysmal cough (day and night)
Anticipatory guidance for management of pertussis:
- Azythromycin or Bactrim PO daily for 5 days
- Should remain in isolation or stay at home from school until they have received 5 days of pharmacologic treatment
- prophylactic Erythromycin for all household contacts
- prevention with vaccinations
Treatment of choice for Influenza;
Oseltamivir (TAMIFLU) may be given within 48 hours of symptom onset
Influenza vaccination are contraindicated in which populations?
- History of egg allergy and anaphylactic reaction
- History of Guillan-Barre syndrome
Anticipatory guidance for children younger than 9 years who are receiving the influenza vaccination for the first time:
Must receive two doses of the vaccination at least 1 month apart
Rubella is characterized by:
Generalzed erythematous maculopapular discrete rash (first indication of illness)
Lymphadenopathy (precedes rash)
Red eruptions with white centers on buccal mucosa
Occur prior to appearance of rash associated with Rubeola (Red measles)
Roseola (Exanthem Subitum) diagnostic criteria:
Previously healthy infant, usually 9 to 12 months of age
Sudden onset of high fever for 3-4 days
Resolution of fever followed by truncal red macules and papules
Anticipatory guidance to parents of infants with Roseola (Exanthem Subitum):
Provide reassurance that appearance of rash is a sign of recovery
Which infectious condition is characterized by bilateral erythema on cheeks with circumoral pallor ("slapped cheek appearance")
Erythema Infectiosum (Fifth Disease)
Which criteria is diagnostic for Erythema Infectiosum (Fifth Disease)
The clinical appearance of the classic "slapped cheek appearance" rash with a generalized lacy-reticular exanthem on the extremities and torso
Mumps is characterized by swelling of which glands in particular?
Rocky Mountain Spotted Fever (RMSF) is transmitted to humans via:
What is the drug of choice for Rocky Mountain Spotted Fever and Lyme Disease?
Lyme disease is tranmmitted to humans via:
Pathogen causing Lyme disease is:
Classic clinical presentation of Lyme disease:
Presence of rash, 1-2 days after a tic bite
Well-circumscribed, erythematous annular rash with central clearing (ERYTHEMA MIGRANS); painless and not pruritic
Causative agent of Infectious Mononucleosis:
Clostridium botulinum spores are often associated with which food products?
- Canned fruits, vegetables, and fish products
What is the diagnostic test of choice for C. botulinum?
Stool culture - positive for clostridium botulinum
What is the treatment of choice for Clostridium Botulinum?
Human-derived antitoxin (botulism immune globulin intravenous, BabyBIG)
What anticipatory guidance should be provided to prevent C. botulinum ingestion?
Avoid feeding honey to infants younger than 12 months of age!!
Poliomyelitis is characterized by:
- Acute flaccid paralysis and muscle weakness
- Decreased tone, motor function and DTRs
- Meningeal signs (HA, stiff neck, spinal rigidity, and nausea)
- Hx of inadequate immunization or recent immunization
Preventive measures of poliomyelitis include:
Active immunization with vaccine (IPV vaccine)
What is the neurotoxin responsible for causing tetanus (lockjaw)?
Clostridium tetani; usually found in contaminated wounds
Manifestations of tetanus (lockjaw):
- Begins with pain at site of wound
- Regional muscle spasm
- After 48 hours there is difficulty opening the jaw (TRISMUS)
- Generalized tetany (muscle rigidity)
What are the clinical manifestations of tetanus in infants?
- First, irritability and inability to nurse or feed
- Followed by stiffness of jaw, neck and increasing dysphagia
- Hyperreflexia and rigidity
What is given to the patient with tetanus to prevent the circulating toxin from binding to the central nervous system sites?
Human tetanus immune globulin (TIG)
What is the first-line pharmacologic therapy for MRSA?
Trimethoprim (TMP)/Sulfamethoxazole (SMX) - BACTRIM
What is the first-line treatment for hospital-acquired MRSA?
What diagnostic tests confirm HIV?
Western Blot test
What pharmacologic management options are there for HIV?
HAART (Highly active antiretroviral therapy)
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