Diagnosis & Treatment Pediatrics
Mucocutaneous lymph node syndrome Kawasaki Disease
Rash on trunk and extremities,
Red palms & soles Kawasaki Disease
Fever > 5days and 4 of the following:
1. Conjunctivitis
2. Rash
3. Mucosal changes
4. Edema of hands/feet
5. Cervical adenopathy Kawasaki Disease: warm + CREAM =
Fever +
Conjunctivitis,
Rash (polymorphous),
Extremity changes (hand & feet rash, induration), Adenopathy (cervical, erythematous, no pus),
Mucous membrane involvement (strawberry tongue, lip swelling)
Most common in children, esp < 5 years old; Asians highest risk and thought to occur after
respiratory pathogen or viral syndrome Kawasaki Disease
Treatment for Kawasaki Disease: IVIG (IV Immunoglobulin) + Aspirin
Which of the following is the treatment of choice for Kawaski's disease?
A. Methotrexate
B. Prednisone
C. Pencillin
D. Aspirin D. Aspirin
Patients with Kawasaki's disease present with fever, bilateral conjunctival injection, pharyngeal
erythema, edema of the hands and feet, rash, and LAD. Tx of choice is high-dose aspirin and IV
immunoglobulin
A 3-year-old boy is seen in the office with a 5-day history of fever, erythema, edema of the
hands and feet, a generalized rash over the body, bilateral conjunctival injections, fissuring and
erythema of the lips, and cervical adenopathy. Antistreptolysin A (ASO) titer and throat culture
are negative. The most serious systemic complication associated with this disorder is
A. renal.
B. cardiac.
C. pulmonary.
D. hepatic. Cardiac
The patient most likely has Kawasaki syndrome. The major complication with this disorder is
coronary artery aneurysms, which are reported in up to 20% of affected children. The etiology of
this disorder is uncertain, although a bacterial toxin with super antigen properties may be
involved.
Polymorphous exanthema is seen in patients with disease. Kawasaki disease
A two-month-old infant appeared well until three weeks ago when he became dyspneic and had
difficulty feeding. A 4/6 holosystolic murmur is heard at the left lower sternal border in the 3rd
ICS. An electrocardiogram (ECG) shows left and right ventricular hypertrophy. Which of the
following is the most likely diagnosis?
,A. Atrial septal defect
B. Pulmonary hypertension
C. Ventricular septal defect
D. Tricuspid insufficiency C. Ventricular septal defect
This is a classic presentation for a ventricular septal defect.
A 3 month-old female presents with her mom for physical examination. The patient's mom
denies any complaints. On examination, you note a well-developed, well-nourished infant in no
apparent distress. There is no cyanosis noted. Heart examination reveals a normal S1 with a
physiologically split S2. There is a grade III/VI high-pitched, harsh, pansystolic murmur heard
best at the 3rd and 4th left intercostal spaces with radiation across the precordium. Which of the
following is the initial diagnostic study of choice in this patient?
A. CT angiogram
B. Electrocardiogram
C. Echocardiogram
D. Cardiac catheterization C. Echocardiogram
Echocardiogram is the initial diagnostic study of choice in the diagnosis of a VSD.
Most commonly causes a holosystolic murmur as its most notable ausculatory finding rather than
a continuous machinery-like murmur. Characterized by a holosystolic murmur at the LLSB.
Ventricular septal defect = MC form of congenital heart disease
Which of the following valvular heart abnormalities will most likely be seen on
echocardiography as a complication of acute myocardial infarction?
A. Aortic stenosis
B. Aortic regurgitation
C. Mitral stenosis
D. Mitral regurgitation D. Mitral regurgitation
In patients with acute myocardial infarction, echocardiogram can show the severity of mitral
regurgitation and the presence of VSD if one is present. Acute inferior wall myocardial
infarction is associated with acute mitral regurgitation due to necrosis of the posterior papillary
muscle which is supplied by the right coronary artery.
Fungal infection of body surfaces other than the feet, groin, face, scalp hair, or beard hair;
annular rash with raised borders and central clearing Tinea corporis = trunk, legs, arms, or neck
One or more, asymmetrically distributed, annular, well-demarcated erythematous scaling plaques
with central clearing. Inflammatory forms may be frankly pustular or vesicular at the borders.
Tinea corporis = trunk, legs, arms or neck! Characterized by raised rings of erythema that
have an advancing scaly border and central clearing. It occurs on skin regions other than scalp,
groin, palms, and soles. Diagnosis is confirmed by KOH prep or culture
Usually seen in younger children or in young adolescents with close physical contact to others
(i.e., wrestlers).
______ is the most common cause of tinea corporis.
Lesions may occur anywhere on the body. Tinea corporis = trunk, legs, arms, or neck; T.
rubrum is the MCC
Treatment of Tinea corporis, which is classically described as pink to red raised rings, or annular
patches with scaly borders and a central area of clearing: Topical azole antifungals: 1%
clotrimazole, Lotrimin, 2% ketoconazole or 1% terbinafine cream, Lamisil, applied twice daily
for 2-4 weeks
, A 5-year-old girl is brought to your clinic by her mother because she has developed a rash on her
arms and trunk after playing with a neighborhood cat several days ago. Which of the following
physical examination findings would suggest a diagnosis of tinea corporis?
A. Annular lesions with erythematous advancing borders and a central clearing
B. Velvety, hypopigmented macules
C. Erythematous morbilliform rash
D. Salmon-colored oval papules
E. Copper-colored annular plaques with scaling A. Annular lesions with erythematous
advancing borders and a central clearing
This description is commonly associated with tinea corporis. Lesions are often pruritic with fine
scales. It can be contracted by direct contact with another infected person, or through contact
with infected animals. KOH prep will show hyphae. It is treated with topical antifungal agents.
A six-year-old child presents with circular patches of baldness and hair that fluoresces yellow-
green under a Woods lamp. Which of the following would be the best treatment? Oral
Griseofulvin; Tinea capitis is best treated with Oral Griseofulvin until the lesions clear, usually
4-8 weeks.
Dermatology: Dermatitis Dermatology: Dermatitis
Patient will present with → tender inflammatory nodules and abscesses in her axillae and
anogenital area. The lesions have waxed and waned over the past few years but have become
more painful and bothersome in the past month. Some of the larger lesions are draining a
purulent material. Hidradenitis suppurativa
Chronic follicular occlusive disease manifested as recurrent inflammatory nodules, abscesses,
sinus tracts, and complex scar formation; Lesions are tender, malodorous, often with exudative
drainage. Common in intertriginous skin regions: axillae, groin, perianal, perineal,
inframammary skin; Most common in women, ages 20-30 years. Hidradenitis suppurativa
Diagnosis is by examination.
Cultures should be taken from deep abscesses and sinus tracts in patients who have chronic
disease, but often no pathogens will be found. The Hurley staging system describes the severity
of disease. Hidradenitis suppurativa
A 17-year-old teenage boy comes to the clinic with an inflamed mass in the right axilla for five
days. Physical examination shows a 4 cm indurated, deep-seated mass that is tender to palpation.
The patient is afebrile. There is no streaking or fluctuance. He reports that he has had similar
bumps in the area on and off over the past year, that usually resolve after about one week. Which
of the following is the most likely diagnosis?
A. Hidradenitis suppurativa
B. Cellulitis
C. Abscess
D. Erysipelas
E. Boils A. Hidradenitis suppurativa
HS arises from a chronically clogged apocrine gland. Diagnosis of this condition is based upon
clinical characteristics, and does not require a biopsy. The three main factors to consider if this
diagnosis is suspected are: 1) lesions must be typical for HS - round, deep nodules that may
appear alone or in groups, 2) lesions must appear in typical locations - most often in axilla, groin,
or inframammary area, and 3) chronicity or relapses are common.
Mucocutaneous lymph node syndrome Kawasaki Disease
Rash on trunk and extremities,
Red palms & soles Kawasaki Disease
Fever > 5days and 4 of the following:
1. Conjunctivitis
2. Rash
3. Mucosal changes
4. Edema of hands/feet
5. Cervical adenopathy Kawasaki Disease: warm + CREAM =
Fever +
Conjunctivitis,
Rash (polymorphous),
Extremity changes (hand & feet rash, induration), Adenopathy (cervical, erythematous, no pus),
Mucous membrane involvement (strawberry tongue, lip swelling)
Most common in children, esp < 5 years old; Asians highest risk and thought to occur after
respiratory pathogen or viral syndrome Kawasaki Disease
Treatment for Kawasaki Disease: IVIG (IV Immunoglobulin) + Aspirin
Which of the following is the treatment of choice for Kawaski's disease?
A. Methotrexate
B. Prednisone
C. Pencillin
D. Aspirin D. Aspirin
Patients with Kawasaki's disease present with fever, bilateral conjunctival injection, pharyngeal
erythema, edema of the hands and feet, rash, and LAD. Tx of choice is high-dose aspirin and IV
immunoglobulin
A 3-year-old boy is seen in the office with a 5-day history of fever, erythema, edema of the
hands and feet, a generalized rash over the body, bilateral conjunctival injections, fissuring and
erythema of the lips, and cervical adenopathy. Antistreptolysin A (ASO) titer and throat culture
are negative. The most serious systemic complication associated with this disorder is
A. renal.
B. cardiac.
C. pulmonary.
D. hepatic. Cardiac
The patient most likely has Kawasaki syndrome. The major complication with this disorder is
coronary artery aneurysms, which are reported in up to 20% of affected children. The etiology of
this disorder is uncertain, although a bacterial toxin with super antigen properties may be
involved.
Polymorphous exanthema is seen in patients with disease. Kawasaki disease
A two-month-old infant appeared well until three weeks ago when he became dyspneic and had
difficulty feeding. A 4/6 holosystolic murmur is heard at the left lower sternal border in the 3rd
ICS. An electrocardiogram (ECG) shows left and right ventricular hypertrophy. Which of the
following is the most likely diagnosis?
,A. Atrial septal defect
B. Pulmonary hypertension
C. Ventricular septal defect
D. Tricuspid insufficiency C. Ventricular septal defect
This is a classic presentation for a ventricular septal defect.
A 3 month-old female presents with her mom for physical examination. The patient's mom
denies any complaints. On examination, you note a well-developed, well-nourished infant in no
apparent distress. There is no cyanosis noted. Heart examination reveals a normal S1 with a
physiologically split S2. There is a grade III/VI high-pitched, harsh, pansystolic murmur heard
best at the 3rd and 4th left intercostal spaces with radiation across the precordium. Which of the
following is the initial diagnostic study of choice in this patient?
A. CT angiogram
B. Electrocardiogram
C. Echocardiogram
D. Cardiac catheterization C. Echocardiogram
Echocardiogram is the initial diagnostic study of choice in the diagnosis of a VSD.
Most commonly causes a holosystolic murmur as its most notable ausculatory finding rather than
a continuous machinery-like murmur. Characterized by a holosystolic murmur at the LLSB.
Ventricular septal defect = MC form of congenital heart disease
Which of the following valvular heart abnormalities will most likely be seen on
echocardiography as a complication of acute myocardial infarction?
A. Aortic stenosis
B. Aortic regurgitation
C. Mitral stenosis
D. Mitral regurgitation D. Mitral regurgitation
In patients with acute myocardial infarction, echocardiogram can show the severity of mitral
regurgitation and the presence of VSD if one is present. Acute inferior wall myocardial
infarction is associated with acute mitral regurgitation due to necrosis of the posterior papillary
muscle which is supplied by the right coronary artery.
Fungal infection of body surfaces other than the feet, groin, face, scalp hair, or beard hair;
annular rash with raised borders and central clearing Tinea corporis = trunk, legs, arms, or neck
One or more, asymmetrically distributed, annular, well-demarcated erythematous scaling plaques
with central clearing. Inflammatory forms may be frankly pustular or vesicular at the borders.
Tinea corporis = trunk, legs, arms or neck! Characterized by raised rings of erythema that
have an advancing scaly border and central clearing. It occurs on skin regions other than scalp,
groin, palms, and soles. Diagnosis is confirmed by KOH prep or culture
Usually seen in younger children or in young adolescents with close physical contact to others
(i.e., wrestlers).
______ is the most common cause of tinea corporis.
Lesions may occur anywhere on the body. Tinea corporis = trunk, legs, arms, or neck; T.
rubrum is the MCC
Treatment of Tinea corporis, which is classically described as pink to red raised rings, or annular
patches with scaly borders and a central area of clearing: Topical azole antifungals: 1%
clotrimazole, Lotrimin, 2% ketoconazole or 1% terbinafine cream, Lamisil, applied twice daily
for 2-4 weeks
, A 5-year-old girl is brought to your clinic by her mother because she has developed a rash on her
arms and trunk after playing with a neighborhood cat several days ago. Which of the following
physical examination findings would suggest a diagnosis of tinea corporis?
A. Annular lesions with erythematous advancing borders and a central clearing
B. Velvety, hypopigmented macules
C. Erythematous morbilliform rash
D. Salmon-colored oval papules
E. Copper-colored annular plaques with scaling A. Annular lesions with erythematous
advancing borders and a central clearing
This description is commonly associated with tinea corporis. Lesions are often pruritic with fine
scales. It can be contracted by direct contact with another infected person, or through contact
with infected animals. KOH prep will show hyphae. It is treated with topical antifungal agents.
A six-year-old child presents with circular patches of baldness and hair that fluoresces yellow-
green under a Woods lamp. Which of the following would be the best treatment? Oral
Griseofulvin; Tinea capitis is best treated with Oral Griseofulvin until the lesions clear, usually
4-8 weeks.
Dermatology: Dermatitis Dermatology: Dermatitis
Patient will present with → tender inflammatory nodules and abscesses in her axillae and
anogenital area. The lesions have waxed and waned over the past few years but have become
more painful and bothersome in the past month. Some of the larger lesions are draining a
purulent material. Hidradenitis suppurativa
Chronic follicular occlusive disease manifested as recurrent inflammatory nodules, abscesses,
sinus tracts, and complex scar formation; Lesions are tender, malodorous, often with exudative
drainage. Common in intertriginous skin regions: axillae, groin, perianal, perineal,
inframammary skin; Most common in women, ages 20-30 years. Hidradenitis suppurativa
Diagnosis is by examination.
Cultures should be taken from deep abscesses and sinus tracts in patients who have chronic
disease, but often no pathogens will be found. The Hurley staging system describes the severity
of disease. Hidradenitis suppurativa
A 17-year-old teenage boy comes to the clinic with an inflamed mass in the right axilla for five
days. Physical examination shows a 4 cm indurated, deep-seated mass that is tender to palpation.
The patient is afebrile. There is no streaking or fluctuance. He reports that he has had similar
bumps in the area on and off over the past year, that usually resolve after about one week. Which
of the following is the most likely diagnosis?
A. Hidradenitis suppurativa
B. Cellulitis
C. Abscess
D. Erysipelas
E. Boils A. Hidradenitis suppurativa
HS arises from a chronically clogged apocrine gland. Diagnosis of this condition is based upon
clinical characteristics, and does not require a biopsy. The three main factors to consider if this
diagnosis is suspected are: 1) lesions must be typical for HS - round, deep nodules that may
appear alone or in groups, 2) lesions must appear in typical locations - most often in axilla, groin,
or inframammary area, and 3) chronicity or relapses are common.
