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86 Cards in this Set

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A 4 day old is noted to have a clustered group of vesicles with an erythematous base on her buttocks. She was born vaginally and these were not noted until now. What is the diagnosis and treatment
HSV. Treat with IV acyclovir
A neonate was noted to have a cluster of vesicular lesions so a Wright stain was ordered and it showed multinucleated giant cells and eosinophilic intranuclear inclusions. What is the diagnosis and treatment?
HSV. Treat with IV acyclovir
A neonate is noted to have a linear pattern of vesicles without an erythematous base. What is this?
Incontinentia pigmenti
An African American neonate is noted to have multiple pustules, brown macules and vesicles on a non-erythematous base that are first noted at birth. Stain shows PMNs, but no organisms. What is this and what is the treatment?
Benign neonatal pustular melanosis. Do nothing.
A 2 day old is NOW noted to have developed yellow pustules with an erythematous base. What do you expect on Wright stain? How do you treat?
Eosinophils. This is E-Tox. Erythema toxicum neonatorium. Do nothing.
A one day old has an erythematous macule around her breast with occasional vesicles in the center. What is this?
Erythema toxicum.
A neonate has diffuse scaling, erythematous papules and pustules in her diaper area. What is this?
Cutaneous candidiasis
Which two types of eczema are non-atopic?
Nummular and Contact Dermatitis
A 4yo comes in with wheals behind her knee. Her mother says the child is constantly scratching herself. You note lichenification behind her knees and on the back of her arms. The child has history of asthma, allergic rhinitis and at birth it was noted she had a high IgE level in the cord blood. What is this?
Atopic dermatitis
True or False.
Food can cause eczema flare.
True. Specific foods, for specific kids can cause flare
True or False.
Breastfeeding for 6 months can prevent eczema.
True
A 2yo is diagnosed with eczema and prescribed emollients and high potency steroids, but there is still no improvement. What is your next step?
Try antibiotics aimed at S. aureus. There may be a superinfection
A 2yo who continues to suck her thumb seems to have inflammation of her eczema around her mouth. She has had emollients, steroids, and antibiotics, but no resolution. Now the lesions appear to be vesicular and crusted over. What is your next step?
Do a Tzank smear and treat with acyclovir.
What is this?
Nummular Eczema
How do you distinguish atopic dermatitis from the following:
Wiskott Aldrich Syndrome
Hyper IgE syndrome
Scabies
Wiskott Aldrich: Immunodeficiency will also be present
Hyper IgE: Severe elevation in IgE
Scabies: Palms and Soles are not spared.
What is this? How do you treat this?
Sebhorrheic Dermatitis. Treat with topical antifungal or topical steroids
An 11 month old presents with this rash and with profuse discharge from his ear and recurrent otitis media. What is this?
Langerhans Histiocytosis X
Which of the following regarding poison ivy is true?
A) Exposure in the winter does not cause a rash
B) Fluid from the vesicles is contagious
C) Once the sap is removed from the clothes, the rash cannot spread
D) Barrier preparations can protect from exposure and one can undergo desensitization if unavoidable exposure.
E) There is no way to prevent rash once exposure has occurred
C is true.
Winter exposure can cause a rash. Fluid from vesicles can not spread the rash
Barrier protection can protect from exposure but there is no desensitization treatment
If you wash right away with soap, you can prevent the rash.
Lesions are oozing and crusting. What is it?
Non-bullous impetigo
Lesions are round, oozing, with crusting erosions and dry macules in a fine scaly pattern. What is it?
Nummular eczema
Lesions are small oval, thick scaling plaques with the long axis of the lesions parallel to the lines of skin stress. What is it?
Pityriasis rosea
Lesions are thin and scaly with central clearing. What is it?
Tinea corpus
What is the red spot?
Auspitz sign. This is pinpoint hemorrhage in psoriasis
A 4yo child presents in early spring with this rash. What is this?
Herald patch of pityriasis.
What are these small, ova, thick scaling plaques?
Pityriasis
How do you distinguish lesions of pityriasis from the following:
1. Secondary syphilis
2. Nummular eczema
3. Tinea Corpis
4. Tinea versicolor
1. Secondary syphilis will have generalized LAD and will often involve the palms and soles.
2. Nummular eczema will have crusting erosions
3. Tinea Corpis will have an elevated border with central clearing
4. Tinea versicolor will not be plaques. They will be hypopigmented scaling macules
Skin is dry with thin scales that look pasted on a preschooler. What is this and what is the treatment?
Ichthyosis Vulgaris. Treat with ammonium lactate, alpha hydroxy acid and urea containing emollients.
True or False.
Patient with Icthyosis Vulgaris are usually spared from atopic dermatitis.
False.
A child has just returned from a week of swim camp. She comes in with a red papular lesion on her foot. What is the bacterial etiology?
Atypical Mycobacteria.
Is this granuloma annulare or ringworm?
Granuloma annulare on the dorsum of the hand. The nodules are arranged in an annular configuration.
Is this granuloma annulare or ringworm?
Tinea corporis with a ring within a ring.
A 8yo girl presents with a pruruitic rash on the soles of her feet. The rash has minimal scaling, thickening of the skin, hyperlinearity of the distal soles. The interdigital skin is normal. How do you treat her?
This is juvenile plantar dermatosis which is a form of contact dermatitis and is a result of occlusive shoes and synthetic socks. Treat with a steroid cream such as triamcinolone.
True or false.
Granuloma annulare does not have epidermal involvement. It does not break the skin and is non-scaling.
True
True or False.
Treatment of impetigo caused by Strep. prevents post-strep GN.
False. It does not.
A preschooler comes in for followup after being treated with antibiotics for an ear infection. She now has a rash. They are tender and red and spread like a sheet over the skin. What is this and how do you treat?
Staphylococcal scalded skin syndrome. It is caused by a toxin and antibiotics are the treatment of choice. It affects preschoolers because their kidney is not mature enough to excrete the toxin.
What is Nikolsy's sign?
It is where slight rubbing will result in blistering.
What do these four have in common?
1. Staphylococcal scalded skin syndrome
2. Toxic epidermal necrolysis
3. Stevens-Johnson syndrome
4. Pemphigus vulgaris
They are all conditions with a positive Nikolsky sign
A child presents after completing an antibiotic regimen, develops a rash on the distal extremities. The rash is macular papular with some lesions dusky in the center. She also has 1-2 lesions on her mouth. The child is otherwise well appearing. What is the diagnosis?
A) SSSS
B) Erythema multiforme minor
C) Erythema multiforme major (aka SJS)
D) TEN
B. Because the child is well appearing, this is erythema multiforme minor.
A 4yo has just a course of bactrim for a UTI. He presents to the ED with fever, muscle aches, joint aches and the following rash. The rash began on her skin, but now it has spread to her lips, conjunctiva, oral mucosa and anogenital mucosa. What is your diagnosis and treatment?
She should be admitted to burn unit, hydrated and given antibiotics to prevent superinfection.
What are two differences between TEN and SJS?
SJS is <30% skin involvement and there is no separation of skin into sheets.

TEN has > 30% skin involvement and separation of skin into sheets.
How do you do distinguish TEN from SSSS?
Exposed skin in SSSS is not red, because it does not penetrate dermis. TEN is red because it penetrates the dermis.

Also SSSS is in young kids, TEN is in TEENS...older kids
What kind of toxin causes each of the following?
1. SSSS
2. Toxic Shock Syndrome
3. Scarlet Fever
4. TEN (toxic epidermal necrolysis)
1. SSSS- exotoxin produced by S. aureus.
2. Toxic Shock Syndrome - Toxin of S. aureus or Strep
3. Scarlet Fever - toxin of Group A strep
4. TEN - not toxin mediated
A child who has CF presents with boggy blue ulcers on her feet. Her foot looks black and the ulcers have a necrotic base. What is the likely diagnosis?
Pyoderma gangrenosum
A 14yo girl Tanner Stage 5, comes in with fever, hypotension and altered mentation. What is your suspicion?
Toxic Shock syndrome
A febrile 7yo comes in with a well demarcated area of her ankle being erythematous and containing multiple bullae. What is the treatment?
This is cellulitis. Give cefazolin
Lesions are linear papules and pustules. Some have crusted over and they are on the wrists, axilla, groin, soles and palms. The skin is itchy and on exam you can see a burrow. What is your management?
Give permethrin cream to child and all family members.

Scabies leaves track marks and can be stopped with a "permanent train" (permethrin)
A child presented with lesions on her face, hands and soles. You diagnosed her with scabies and treated with permethrin, and the rash improved, but she still has itching. What should you do?
Give topical steroids. This is inflammatory reaction, not a treatment failure.
A 7yo girl presents with blue-gray macules on her abdomen and inner thigh, she complains of pubic pruritis. What do you suspect?
Pubic Lice. Suspect sexual abuse.
How long can crab lice live without a blood meal?
36 hours
How long can the eggs on hair shafts take to hatch?
10 days
True or False.
Pubic lice can exist on facial hair.
True
Which are faster moving? Pubic lice or head lice?
Head lice
True or False.
Pubic lice and head lice are more frequent in African American kids.
False. Pubic lice have equal racial impact and head lice rarely infect African Americans
How do you treat lice of eyelashes?
Vaseline TID for 10 days
What is the treatment of this lesion?
Nothing. This is molluscum.
These pink, erythematous excoriated papules have a central punctum. They last about ten days. No other family members have these lesions. What are these and how do you treat it?
This is papular urticaria. Treat by identifying the causative agent.
How do you distinguish biotin deficiency and zinc deficiency?
biotin deficiency also has ataxia
What is the treatment for this boy's condition? What is the gold standard for the diagnosis?
Treat with griseofulvin. Fungal culture is gold standard of treatment.
What is the treatment for alopecia areata?
reassurance then steroids.
What is telogen effluvium?
The sudden loss of large amounts of hair during routine activities such as washing and brushing hair.
A hospitalist studying for boards notes a large ball of hair falling out as she brushes her hair getting ready for work. Her husband notes a large round, bald patch. What is this?
Telogen Effluvium. It is caused by stress, febrile illness or surgery.
A 9yo is noted to have irregular patches of incomplete hair loss. What is this?
Trichotillomania
A child has mastocytosis, or urticaria pigmentosum. As such, she has pigmented lesions that turn into hives with rubbing. Her parents want to know what they can do to help their daughter. How do you respond?
1. Avoid vigorous toweling after baths.
2. Avoid histamine releasers such as hot spicy food, aspirin, codeine, radiologic contrast materials
3. Antihistamines (hydroxyzine, cyproheptadine, ketotifen) if patient is symptomatic
4.Topical corticosteroids during periods of acute urtication
A 17yo surfer comes in complaining his back looks splotchy. What is this? How do you treat it?
Tinea versicolor. Treat with astringents, topical antifungals, and avoiding the sun.
Xeroderma pigmentosum puts patients at increased risk of skin cancer and may lead to death. How can you decrease this risk?
Avoid UV light and sun
A child has a port wine stain in trigeminal nerve distribution of his right cheek. He also has a seizure disorder and is cognitively impaired. What is the diagnosis?
Sturge webber syndrome
What diagnostic test will reveal venous leptomeningeal angiomatosa
MRI
True or False.
The size of a port wine stain does not correlate with severity of venous leptomeningeal angiomatoma.
True
How do you reverse the port wine stain?
Tunable dye laser.
What is the ocular disease associated with sturge webber syndrome?
Glaucoma
What are the three organ systems involved in neurofibromatosis?
CNS, Orthopedic, and Skin
What is the fundamental difference between type 1 and type 2 neurofibromatosis?
Type 1 is peripheral. Type 2 is central.
How many of the following criteria are needed to diagnose Von Recklinghausen Disease?

Cafe au lait spots (>6 in number and > 4mm diameter)
Neurofibromas
Optic nerve glioma
Lisch nodules (on slit lamp exam)
Inguinal and Axilary Freckling
Bony Defects
Family History of NF1 in 1st degree relative.
Two
What is the genetic inheritence of NF1?
Autosomal Dominant
A child with known NF1 has hypertension. What are the two suspected causes that are particular to NF1?
Pheochromocytoma and Renal Artery Stenosis
Fill in the blanks....
Nero is playing a fiddle and drinking .... cups of .... in a .... mm cup
6 cups of cafe au lait in 4mm cup
What is this?
An ash leaf spot.
What is this?
Tuberous sclerosis
What is the difference between strawberry hemangiomas and angiomas in Kasabach-Merrit syndrome?
Strawberries are at birth and resolve after one year. Kassabach has abrupt onset after birth.
When and how do you treat a strawberry hemangioma?
When it interferes with vision, breathing, eating, hearing or normal functions. Treat with steroids and laser.
By default where is a blue hemangioma located?
In the deep dermis
What is this?
Shagreen patch. Not the cobblestone skin with orange peel appearance. It can be found in kids with tuberous sclerosis?
What is the cause of this?
Parvovirus B19
A child has the following lesion. What else would you expect this child to develop if her disease goes untreated?
Erythema chronicum migrans
Carditis
Arthritis
Neuritis
What is this?
Erythema Nodosum. It is associated with TB, OCP, IBD and fungal infections
What is the diagnosis, etiology, treatment and complication of this?
This is rheumatic fever.
Treat with Steroids and antibiotis
It is caused by s. pyogenes or aspirin
Complication is carditis