JEOPARDY Visual Diagnosis Pennsylvania Coalition of Nurse Practitioners 8 th Annual Conference...

JEOPARDYVisual

DiagnosisPennsylvania Coalition of Nurse Practitioners

8th Annual Conference

November 12-13, 2010

Baby Bummer

s

Describe This Rash

Rings and

Things

The Dark Side

Fingers and Toes

Potpourri

100 100 100 100 100 100

200 200 200 200 200 200

300 300 300 300 300 300

400 400 400 400 400 400

500 500 500 500 500 500

Baby Bummers 100

Answer

Baby Bummers 100 Answer

Question

Babby Bummers 100

Neonatal Acne• Erythematous papules or pustules• Resembles acne vulgaris as seen in adolescents• May be present at birth or develop in early infancy• Usually on cheeks, occasionally affects chin and

forehead• Etiology not clearly defined – may be due to hormonal

stimulation of sebaceous glands that have not yet involuted

• No treatment necessary in most cases

Baby Bummers 200

Answer


Question

Seborrheic Dermatitis

• In newborns and infants often begins in 1st 12 weeks of life• May start with scaly dermatitis of scalp (cradle cap)• May spread over face including the forehead, ears,

eyebrows, nose and back of head• Erythematous, greasy, salmon colored, and sharply

marginated oval scaly lesions may involve other parts of the body

• Prognosis is good – some clear in 3 to 4 weeks, even without treatment and most clear spontaneously by 8 to 12 months of age

• Rx: apply baby or mineral oil to scalp, leave on overnight, remove scales with soft baby brush or tooth brush in am and wash off

Baby Bummers 300

Answer


Question

Eczema/Atopic Dermatitis

Baby Bummers 400

Answer


Question

Intertrigo

• Erythematous rash in neck folds (or other intertriginous areas) characterized by superficial inflammation

• Can become secondarily infected by yeast or bacteria

• Treat like diaper rash

Baby Bummers 500

Answer


Question

Erythema Toxicum Neonatorum

• Benign, self-limited condition, etiology unknown

• Blotchy, evanescent erythematous macules, sometimes with associated small papules, vesicles and pustules on erythematous base

• Lesions disappear and reappear at different locations

• Peak onset at 48 hours after birth, generally resolves by 5-14 days of life

Describe This Rash 100

Answer

Describe This Rash 100 Answer

Question

Vesicular exanthem, “teardrop” vesicles on an erythematous base =

Varicella

• All stages and sizes of lesions may be found at the same time and in the same vicinity

• Eruption usually begins abruptly on the trunk, face and scalp, with successive crops of pruritic lesions – minimal involvement of distal aspect of extremities


Answer


Question

Erythematous maculopapular rash

• Roseola Infantum (exanthem subitum = sixth disease)

• Eruption characterized by discrete rose pink macules or maculopapules 2-3 mm in diameter that fade on pressure and rarely coalesce.

• Usually appears on trunk and may spread to neck, upper and lower extremities


Answer


Question

Erythematous raised oval/round papules and macules, (wheals) some with central clearing, some with

coalescence=Urticaria (hives)

• Typical lesions have a white palpable center of edema with a variable halo of erythema.

• Vary from pinpoint sized papules to large lesions several cms in diameter

• Central clearing, peripheral extension and coalescence of individual lesions result in oval, annular or bizarre serpiginous configurations


Answer


Question

Small smooth topped papules around corona of penis=Pearly Penile Papules

• Lesions are located on the corona of the penis and occur in 15% of adolescent males;

• Lesions are 1-3 mm in diameter; occurring in 1-5 rows


Answer


Question

Greyish or yellowish white small specks on shafts of hair and erythematous papules with scabs = Lice

• Pediculosis capitis (head lice) and pediculosis pubis (pubic lice) • Can have impetigo of scalp, postoccipital lymphadenopathy, dermatitis

of neck, shoulders and posterior auricular areas. • Nits are small, oval whitish and measure about 0.5 mm in length • Can have erythematous papules with scabs or superinfection in GU area

Rings and Things 100

Answer

Rings and Things 100 Answer

Question

Pityriasis Rosea

• Acute self limited disorder-not contagious• Typically affects teens• Usually lasts 4-14 weeks• Herald patch followed by Christmas tree distribution• Symptomatic treatment for itch


Answer


Question

Granuloma Annulare

• Papules or nodules in a ring typically on the dorsum of hands and feet 1-5cm

• Can occur at any age • Disappear spontaneously months to 2 years• Steroids topically not recommended because of dermal atrophy


Answer


Question

Tinea Corporis

• Annular sharply demarkated scaly patches with clear center, often pruritic

• Usually 1-2 lesions• All ages• Treat with topical antifungal clotrimazole for 2-3 weeks• Organism microsporum or trichophyton


Answer


Question

Tinea Versicolor

• Multiple scaling oval patchy lesions hyper- or hypopigmented• Typically occurs in adolescents• Generally asymptomatic• Treat with selenium sulfide shampoo• Persistent lesions treat with oral ketoconazole


Answer


Question

Erythema Multiforme

• Symmetric eruption on extensor surfaces of arms and legs, backs of hands and feet

• Target lesions macular, urticarial, and vesiculobullous (sharply marginated)

• Often preceded by herpes simplex (history of cold sores)• More severe form: Stevens Johnsons involves mucous membranes• Treatment: supportive care antihistamines

The Dark Side 100

Answer

The Dark Side 100 Answer

Question

Acanthosis Nigricans• Light brown to black verrucous hypertrophic lesions, classically on the

neck, axillae and groin• Familial tendency, obese individuals • May be related to risk diabetes, insulin resistance states• Lac-hydrin and Retin A, periodic abrasion with Buff Puff• Weight loss also can help

The Dark Side 200

Answer


Question

Mongolian Spot• Deep brown to slate gray or blue-black large macular lesions• Typically over lumbosacral areas, buttocks and lower limbs• Seen in over 90% of African American infants, 81% of Asians, 70% of

Hispanics, 9.6% of Whites• Usually fade by age 2 – occasionally persist into adulthood but usually

disappear by age 7-13 years

The Dark Side 300

Answer


Question

Congenital Pigmented Nevus• Most are small (less than 1.5cm diameter) or medium (15 to 20cm) sized • Flat pale hyperpigmented macules or papules, well circumscribed

lesions• Risk of developing malignant melanoma over lifetime (2.5-5%) in

medium size nevus (uncertain)• REFER: very large, irregular pigment, red or blue (different colors),

irregular shape, irregular surface characteristics

The Dark Side 400

Answer


Question

Café au Lait Spot• Large round or oval, flat lesions of light brown pigmentation found in

10-20% of normal individuals• May be a sign of neurofibromatosis: 6 or more spots greater than 1.5cm

in diameter • Look for axillary freckling early sign of NF- freckling called Crowe’s sign

The Dark Side 500

Answer


Question

Linear Epidermal Nevus• Linear arrangement of hypertrophic warty papules • Usually present at birth can appear during early childhood, pruritic• Chronic course resistant to therapy, may need excision if irritating

Fingers and Toes 100

Answer

Fingers and Toes 100 Answer

Question

Onychomycosis• Primarily caused by Trichophyton rubrans and T mentagrophytes• Topical therapy often ineffective, especially as monotherapy; may help

prevent recurrence• Oral therapy with terbinafine (Lamisil), itraconazole (Sporanox);

Terbinafine has pediatric dosing; treat for months, until disease-free nail is seen

• All oral therapy requires periodic (q4-6 week) monitoring of CBC and LFTs

• Consider referral if diagnosis unclear or for possible surgery


Answer


Question

Plantar Wart• Black dots often visible• Caused by HPV• Seen in 7-10% of the population, highest incidence ages 10-19 years of

age• Warts can be spread from one person to another and auto-inoculation

also can occur • Duration ranges from a few months to 5 years or more. 25% disappear

spontaneously in 3-6 months• Treatment: OTC salicylic acid, duct tape?, freezing


Answer


Question

Herpetic Whitlow• Caused by HSV-1 or HSV-2• Often associated with thumb-sucking, or occupational exposure• Primary infection can be associated with systemic symptoms• Topical acyclovir can help primary infection; oral acyclovir can decrease

recurrence in patients with frequent recurrence• Can do scraping for diagnosis, avoid deep incision; always consider

whitlow before incising a paronychia


Answer


Question

Trachyonychia or Twenty-Nail Dystrophy• Longitudinal ridging and roughness of nails • Does not necessarily involve all twenty nails• Associated with psoriasis, lichen planus, alopecia areata, and eczema;

Can also be genetic and unassociated with other skin disease• No treatment; treatment of skin disease does not help nail appearance;

will often improve with age• Can also see nail pitting with psoriasis

Nail Pitting Lichen Planus


Answer


Question

Melanonychia Striata or Longitudinal Melanonychia

• Longitudinal hyperpigmentation of nail matrix• Very common in dark-skinned people, often on multiple nails (77% of

blacks by age 20 years, and it is seen in 90% of blacks by the fifth decade of life)

• Refer to dermatology for evaluation for melanoma if: light-skinned patient, found on single nail, pigmentation of proximal nail fold

Potpourri 100

Answer

Potpourri 100 Answer

Question

Papular Urticaria

• Chronic or recurrent papular eruption caused by sensitivity reaction to the bites of mosquitoes, fleas, bedbugs and other insects

• Primarily seen in children between 2 and 7 years old• Lesions occur on any part of the body but tend to be grouped in

clusters on exposed areas, particularly the extensor surfaces of extremities

Potpourri 200

Answer


Question

Keratosis Pilaris

• Chicken-skin appearance typically on outer aspect of arms and legs but also on the trunk, buttocks and cheeks

• Often seen in association with atopic dermatitis• Treatment with Eucerin Plus, emollients, 5-10% salicylic acid in a

moisturizing cream such as Aquaphor

Potpourri 300

Answer


Question

Erythema Infectiousum =Fifth Disease

• Caused by human parvovirus B19 which is associated with aplastic crisis in sickle cell patients and risk for hydrops fetalis

• Peak incidence: age 3-12 years of age• Three stages:

1. Erythematous malar blush “slapped cheek”: contagious stage

2. Erythematous maculopapular eruption on the extensor surfaces of extremities next day

3. Rash fades with central clearing creating a reticulated pattern which lasts 3-24 days

Potpourri 400

Answer


Question

Scarlet Fever

• Diffuse punctuate erythematous eruption with a sandpaper-like texture• Etiology: group A Beta hemolytic strep and other bacteria• Peak incidence: ages 1- to 10- years• Associated symptoms; sore throat, fever, headaches, vomiting and

malaise

Potpourri 500

Answer


Question

Measles

• “morbilliform” rash – erythematous maculopapular eruption, first on the scalp and hairline, the forehead, the area behind the ear lobes and then upper part of the neck. Then it spreads downward to involve the face, neck, upper extremities and trunk and continues until it reaches the feet by the 3rd day. Rash fades in same order that is appeared

JEOPARDY Visual Diagnosis Pennsylvania Coalition of Nurse Practitioners 8 th Annual Conference...

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