Pediatrics: Chapter 5 Dermatology

Front 1

What is the incubation period for Measles?

Back 1

8-12 days after initial exposure the Paramyxovirus

Front 2

Cough + Coryza + Conjunctivitis = ?

Back 2

Measles

Front 3

Measles

**occur 2-3 days of onset of symptoms (of 3 C's)

Back 3

Small irregular red spots with central gray or bluish white specks...what disease?

Front 4

Measles

Back 4

Approximately 5 days after the onset of symptoms, an erythematous maculopapular rash erupts on the head & spreads caudally, lasting 4-5 days

Front 5

What are 2 severe complications of Measles?

Back 5

Acute Encephalitis

Subacute Sclerosing Panencephalitis

Front 6

This infection has an incubation period of 14-21 days. When symptoms do occur, an erythematous maculopapular, discrete rash, with generalized lymphadenopathy & slight fever. The rash rarely last longer than 5 days. Fever may accompany the onset of rash.

Back 6

Rubella

Front 7

This is common in adolescents with Rubella infection

Back 7

Polyarthralgia & Polyarthritis

Front 8

These 2 things are rare complications of Rubella infection

Back 8

Encephalitis & Thrombocytopenia

Front 9

Common acute disease of infants & young children caused by Human Herpesvirus 6 (HHV-6)

Back 9

Roseola Infantum

Front 10

Illness that begins with an abrupt fever characterized by temps of 103-106F that persists for 1-5 days. During the fever, the child generally appears well & has no physical findings to explain the fever. On the 3rd-4th day, a maculopapular rash appears on the trunk & spread peripherally. The rash typically appears as the fever resolves. Initially, leukocytosis up to 20,000 microliters with a left shift may exist, but by the 2nd day of illness, leukopenia & neutropenia may be noted.

Back 10

Roseola Infantum (HHV-6)

Front 11

What complication may occur in Roseola Infantum?

Back 11

Febrile Seizures due to rapid increase in temp during onset of infection

Front 12

Describe the 3 stages of the rash in Erythema Infectiosum (Fifth Disease)

Back 12

1. marked redness of the cheeks = "slapped cheek"

2. lacy or reticulate, red, pruritic rash then starts on the arms & spreads to trunk & legs

3. Fluctuations in the severity of the rash lasting for 2-3 wks. Fluctuations occur with temp changes & exposure to light

Front 13

What are 3 complications of Erythema Infectiosum?

Back 13

Arthritis

Hemolytic Anemia

Encephalopathy

Front 14

When is Hand-foot-and-mouth disease common? (what part of the year)

Back 14

Spring & Summer

Front 15

What virus causes hand-foot-and-mouth disease?

Back 15

Coxsackie A virus

Front 16

Describe the symptoms of hand-foot-and-mouth disease

Back 16

Prodrome of fever, anorexia, & oral pain

Crops of ulcers on the tongue & oral mucosa & a vesicular rash on the hands, feet, & occasionally buttocks

Individual vesicles often have a "football" shape with surrounding redness

Front 17

When can fatal disseminated Varicella (chickenpox) develop?

Back 17

1. in immunocompromised children

2. neonates whose mothers develop the infection within 1 week of delivery

Front 18

Describe the disease progression of Varicella

Back 18

-incubation of 10-21 days
-prodrome of mild fever, malaise, anorexia, & occasionally a scarlatiniform or morbilliform rash
-Pruritic rash occurs on following day appearing first on the trunk & then spreading peripherally. Rash begins as red papules & develops rapidly into vesicles. Vesicles then become cloudy, break, & form scabs. Lesions occur in widely scattered "crops", so several stages of lesions are usually present at the same time

Front 19

When are patients infectious with Varicella?

Back 19

from 24 hours before the appearance of the rash until all the lesions are crusted, which usually occurs 1 wk after the onset of the rash

Front 20

What 3 things may occur in immunocompromised patients with Varicella infection?

Back 20

1. Meningoencephalitis

2. Hepatitis

3. Pneumonitis

**associated with a 20% mortality rate
**immunization with varicella vaccine has reduced the frequency of this infection in the US

Front 21

This represents a reactivation of Varicella-zoster virus infection & occurs predominately in adults who previously have had varicella & have circulating antibodies

Back 21

Herpes Zoster

Front 22

HOw does Herpes Zoster present?

Back 22

follows a Dermatomal distribution due to dorsal root ganglion storage

begins with pain along the affected sensory nerve & is accompanied by fever & malaise
-a vesicular eruption then appears in crops confined to the dermatomal distribution & clears in 7-14 days

Front 23

What is contraindicated when Varicella is suspected? Why?

Back 23

Ibuprofen b/c of increased risk of Streptococcal Cellulitis

Front 24

Why should Aspirin be avoided when treating fever in the setting of Viral infection?

Back 24

to avoid Reye's Syndrome

Front 25

What may the itching associated with Fifth Disease, Varicella, & Herpes Zoster be treated with?

Back 25

Oral Antihistamine

Front 26

What reduces the risk of secondary bacterial infection with a Chickenpox infection?

Back 26

daily bathing in lukewarm water

Front 27

What are Immunocompromised children who are exposed to Varicella-zoster given?

Back 27

VZIG within 96 hours of the exposure & are observed closely

Front 28

What 2 bacteria cause most bacterial skin infections?

Back 28

group A Beta-hemolytic streptococci

S. aureus

Front 29

What causes Bullous Impetigo?

Back 29

toxin-producing strain of S. aureus

Front 30

Describe the Bullous Impetigo lesions

Back 30

Begin as red macules that progress to bullous (fluid-filled) eruptions on a red base
-range from a few mm to a few cm in diameter

After the bullae rupture, a clear, thin, varnishlike coating forms over the denuded area

Front 31

What can Bullous Impetigo lesions be mistaken for?

Back 31

Cigarette burns, raising the suspicion of abuse

Front 32

Describe Nonbullous Impetigo

Back 32

1. caused by both group A beta-hemolytic + S. aureus

2. begin as papules that progress to vesicles & then to painless pustules measuring approximately 5 mm in diameter with a thin red rim

3. Pustules rupture, revealing a honey-colored thin exudate that then forms a crust over a shallow ulcerated base

4. Lymphadenopathy is common with Strep impetigo (fever is uncommon)

Front 33

What causes Scalded Skin Syndrome? When does it most commonly occur?

Back 33

exfoliative toxin-producing isolate of S. aureus

In infancy & rarely occurs beyond 5 yoa

Front 34

Describe the progression of Scalded Skin Syndrome

Back 34

1. Onset is abrupt
2. Diffuse redness, marked skin tenderness, & fever
3. Within 12-24 hrs, superficial flaccid bullae develop & then rupture almost immediately, leaving a beefy red, weeping surface

Front 35

What does a positive Nikolsky sign mean in SSSS?

Back 35

separation of the dermis on light rubbing

Front 36

Staphylococcal Scalded Skin Syndrome

Back 36

What is this?

Front 37

Furuncles

Back 37

These begin as superficial folliculitis & are most frequently found in areas of hair-bearing skin that are subject to friction & maceration, especially the scalp, buttocks, & axillae

Front 38

What is a Carbuncle?

Back 38

accumulation of furuncles

Front 39

What is the most common cause of hematogenously spread cellulitis?

Back 39

Strep pneumoniae

Front 40

What is limited Nonbullous Impetigo treated with?

Back 40

topical mupirocin ointment

Front 41

What are Bullous Impetigo & Nonbullous Impetigo, if numerous, treated with?

Back 41

First-generation Cephalosporin = Cephalexin
-effective against both Staph & group A Strep

or

Clindamycin or Trimethoprim-Sulfamethoxazole for MRSA

Front 42

How is Scalded Skin Syndrome treated?

Back 42

Mild-Moderate = anti-staph medication

Severe = meticulous fluid management & i.v. Oxacillin or Clindamycin

Front 43

How is Superficial Folliculitis treated?

Back 43

aggressive hygeine & topical mupirocin

**exception -- folliculitis of the male beard is treated with oral antistaph drug

Front 44

How is simple Furunculosis treated?

Back 44

moist heat

Front 45

How are large & deep furuncles treated?

Back 45

Incision & drainage -> topical mupirocin

Front 46

What is the etiologic agent of Tinea Versicolor?

Back 46

Malassezia furfur

Front 47

Tinea Versicolor

Back 47

Superficial tan or hypopigmented oval scaly lesions on the neck, upper part of the back, chest , & proximal arms in a christmas tree distribution

Front 48

What is the treatment for Tinea Versicolor?

Back 48

Selenium Sulfide shampoo or other antifungal agents

Front 49

What can Diaper Rash result from?

Back 49

1. Atopic Dermatitis = a form of eczema, is a non-contagious disorder characterized by chronically inflamed skin and sometimes intolerable itching

2. Primary irritant dermatitis

3. Primary or Secondary Candida infections

Front 50

Topical Nystatin along with Barrier Creams

Back 50

What is the treatment for Candida Diaper Rash?

Front 51

What is the cause of Acne Vulgaris?

Back 51

enlargement of SEBACEOUS GLANDS, increased sebum production, proliferation of Propionibacterium acnes, & secondary inflammation changes

Front 52

What is the stimulus for Sebaceous gland development & secretion leading to Acne Vulgaris?

Back 52

Androgens

Front 53

Why would you want to differentiate common acne from NOdulocystic Acne?

Back 53

Latter causes hypertrophic or pitted scarring

Front 54

This drug works by decreasing the colonization of P. acnes & decreasing the development of microcomedomes by lessening the concentration of free fatty acids

Back 54

Benzoyl Peroxide

Front 55

These drugs have strong anticomedogenic activity; however, side efects may limit use & include dryness, burning, & most importantly photosensitivity by reducing the thickness of the stratum corneum layer

Back 55

Topical Retinoids = TRetinoin, Adapalene, Tazarotene

Front 56

What must be obtained before initiating treatment of Retinoic Acid for acne?

Back 56

Pregnancy test within 2 wks of therapy b/c it is a teratogen
-contraception must be used from 1 month prior to 1 month after therapy

Controversial associations of Isotretinoin & mood alterations have also been reported

Front 57

What is a risk factor for Psoriasis?

Back 57

HLA type C6

Front 58

Psoriasis

Back 58

Nonpuritis rash that consists of red papules that coalesce to form plaques with sharply demarcated borders & a silvery or yellow-white scale. The scales tend to build up into layers, and their removal may result in pinpoint bleeding (Auspitz sign)

Front 59

How do you differentiate b/w Psoriasis & Reiter's Syndrome?

Back 59

Reiter's Syndrome will have lesion of the mucous membrane

Front 60

How do you differentiate b/w Psoriasis & Atopic Dermatitis?

Back 60

Atopic Dermatitis is pruritic & concentrated in flexural creases, whereas psoriasis is not usually pruritic & favors extensor surfaces

Front 61

What is the treatment management of Psoriasis?

Back 61

It is characterized by remissions & exacerbations
-educate patient that the disease is chronic & recurrent & cannot be cured but can be controlled
-keep the skin well hydrated
-Tar preps may be added to the daily bath or used as ointment
-Severe cases = natural sunlight or UVB light in conjunction with Tar lubricant

Front 62

T or F: Psoriasis is pruritic

Back 62

False

Front 63

Acute, self-limited, hypersensitivity reaction that is uncommon in children. Etiologic agents include viral infection (herpes, adenovirus, & Epstein-barr), Mycoplasma pneumoniae infection, drug ingestion (esp Sulfa drugs, immunizations, & food rxns

Back 63

Erythema Multiforme

Front 64

Describe the lesions in Erythema Multiforme

Back 64

Erythematous macules -> Papules -> plaques -> vesicles -> Target lesions

Lesions change over days, not hours

Tend to occur over dorsum of hands & feet, palms & soles, & extensor surfaces of extremities, but may spread to trunk

Burning & itching are common

Systemic manifestations include fever, malaise, & myalgias

Front 65

What is the most common cause of recurrent erythema multiforme in children?

Back 65

Herpes Simplex Virus

Front 66

What is Stevens-Johnson's Syndrome?

Back 66

Most severe form of Erythema Multiforme
-prodrome of 1-14 days of fever, malaise, myalgias, arthralgias, arthritis, headache, emesis, & diarrhea
-followed by sudden onset of high fever, erythema multiforme skin lesions, & inflammatory bullae of 2 or more mucous membranes

Front 67

What are the most common causes of Stevens-Johnson Syndrome?

Back 67

Drugs & Mycoplasma infections

Front 68

Most severe form of cutaneous hypersensitivity & is similar to Staphylococcal Scalded Skin Syndrome in that both result in sloughing of the epidermal layer

Back 68

Toxic Epidermal Necrolysis

Front 69

List the size classifications for Congenital Nevi

Back 69

Large = > 20 cm
Intermediate = 2-20 cm
Small = < 2 cm

Front 70

T or F: Giant/Large Nevi have an increased risk of Melanoma

Back 70

True
-must be followed annually for changes & may require complete excision