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JEOPARDY Visual Diagnosis

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

  2. Baby Bummers 100 Answer

  3. Baby Bummers 100 Answer Question

  4. 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

  5. Baby Bummers 200 Answer

  6. Baby Bummers 200 Answer SeborrheicDermatitis • 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 Question

  7. Baby Bummers 300 Answer

  8. Baby Bummers 300 Answer Eczema/Atopic Dermatitis Question

  9. Baby Bummers 400 Answer

  10. Baby Bummers 400 Answer • 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 Question

  11. Baby Bummers 500 Answer

  12. Baby Bummers 500 Answer • 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 Question

  13. Describe This Rash 100 Answer

  14. Describe This Rash 100 Answer • 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 Question

  15. Describe This Rash 200 Answer

  16. Describe This Rash 200 Answer • 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 Question

  17. Describe This Rash 300 Answer

  18. Describe This Rash 300 Answer • 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 Question

  19. DescribeThis Rash 400 Answer

  20. Describe This Rash 400 Answer • 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 Question

  21. Describe This Rash 500 Answer

  22. Describe This Rash 500 Answer • 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 Question

  23. Rings and Things 100 Answer

  24. Rings and Things 100 Answer • 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 Question

  25. Rings and Things 200 Answer

  26. Rings and Things 200 Answer • 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 Question

  27. Rings and Things 300 Answer

  28. Rings and Things 300 Answer • 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 Question

  29. Rings and Things 400 Answer

  30. Rings and Things 400 Answer • 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 Question

  31. Rings and Things 500 Answer

  32. Rings and Things 500 Answer • 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 Question

  33. The Dark Side 100 Answer

  34. The Dark Side 100 Answer • 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 Question

  35. The Dark Side 200 Answer

  36. The Dark Side 200 Answer • 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 Question

  37. The Dark Side 300 Answer

  38. The Dark Side 300 Answer • 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 Question

  39. The Dark Side 400 Answer

  40. The Dark Side 400 Answer • 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 Question

  41. The Dark Side 500 Answer

  42. The Dark Side 500 Answer • 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 Question

  43. Fingers and Toes 100 Answer

  44. Fingers and Toes 100 Answer • 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 Question

  45. Fingers and Toes 200 Answer

  46. Fingers and Toes 200 Answer • 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 Question

  47. Fingers and Toes 300 Answer

  48. Fingers and Toes 300 Answer • 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 Question

  49. Fingers and Toes 400 Answer