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JEOPARDY Visual Diagnosis Pennsylvania Coalition of Nurse Practitioners 8 th Annual Conference November 12-13, 2010.

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Presentation on theme: "JEOPARDY Visual Diagnosis Pennsylvania Coalition of Nurse Practitioners 8 th Annual Conference November 12-13, 2010."— Presentation transcript:

1 JEOPARDY Visual Diagnosis Pennsylvania Coalition of Nurse Practitioners 8 th Annual Conference November 12-13, 2010

2 Baby Bummers Describe This Rash Rings and Things The Dark Side Fingers and Toes Potpourri

3 Baby Bummers 100 Answer

4 Baby Bummers 100 Answer Question

5 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

6 Baby Bummers 200 Answer

7 Baby Bummers 200 Answer Question Seborrheic Dermatitis In newborns and infants often begins in 1 st 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

8 Baby Bummers 300 Answer

9 Baby Bummers 300 Answer Question Eczema/Atopic Dermatitis

10 Baby Bummers 400 Answer

11 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

12 Baby Bummers 500 Answer

13 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

14 Describe This Rash 100 Answer

15 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

16 Describe This Rash 200 Answer

17 Describe This Rash 200 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

18 Describe This Rash 300 Answer

19 Describe This Rash 300 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

20 Describe This Rash 400 Answer

21 Describe This Rash 400 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

22 Describe This Rash 500 Answer

23 Describe This Rash 500 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

24 Rings and Things 100 Answer

25 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

26 Rings and Things 200 Answer

27 Rings and Things 200 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

28 Rings and Things 300 Answer

29 Rings and Things 300 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

30 Rings and Things 400 Answer

31 Rings and Things 400 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

32 Rings and Things 500 Answer

33 Rings and Things 500 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

34 The Dark Side 100 Answer

35 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

36 The Dark Side 200 Answer

37 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

38 The Dark Side 300 Answer

39 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

40 The Dark Side 400 Answer

41 The Dark Side 400 Answer Question Café au Lait Spot Large round or oval, flat lesions of light brown pigmentation found in % 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

42 The Dark Side 500 Answer

43 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

44 Fingers and Toes 100 Answer

45 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

46 Fingers and Toes 200 Answer

47 Fingers and Toes 200 Answer Question Plantar Wart Black dots often visible Caused by HPV Seen in 7-10% of the population, highest incidence ages 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

48 Fingers and Toes 300 Answer

49 Fingers and Toes 300 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

50 Fingers and Toes 400 Answer

51 Fingers and Toes 400 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 PittingLichen Planus

52 Fingers and Toes 500 Answer

53 Fingers and Toes 500 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

54 Potpourri 100 Answer

55 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

56 Potpourri 200 Answer

57 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

58 Potpourri 300 Answer

59 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

60 Potpourri 400 Answer

61 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

62 Potpourri 500 Answer

63 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 3 rd day. Rash fades in same order that is appeared


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