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* answer for this Archer question
 #835839  
  aravindk - 01/04/17 00:14
 
  You are evaluating a 7-week-old male newborn presenting with a painful and itchy rash on his trunk. Vital signs are taken and demonstrate a temperature of 99.6 F, blood pressure 129/76 mmHg, pulse 84 beats per minute, respiratory rate of 15 breaths per minute, and an O2 saturation of 96% on room air. You perform a physical examination which is largely unremarkable. A basic chemistry panel reveal sodium 140 mmol/L, potassium 3.9 mmol/L, chloride 111 mmol/L, carbon dioxide 49, blood urea nitrogen 25 mg/dL, creatinine 0.9 mg/dL, and glucose 110 mg/dL. Complete blood count shows leukocytes 6,800, Hct 49.5%, Hgb 17.7 g/dL, mean corpuscular volume (MCV) 91 fL, and platelets 312. Urinalysis reveals white blood cells 0 per high powered field, red blood cells 2 per high powered field, protein 130 mg/d, and no ketones or nitrites. Liver function tests are obtained and reveal ALT 55 units per liter, AST 49 units per liter, alkaline phosphatase (AP) 89 units per liter, albumin 4.45 grams per deciliter, total serum protein 6.1 grams per deciliter, and total bilirubin 0.8 milligrams per deciliter. Iron analysis shows ferritin 141 ng/mL, total iron-binding capacity 51 umol/L, total serum iron of 110 ug/dL, and transferrin 298 mg/dL. A lipid panel is ordered and demonstrates total cholesterol 4.9 mmol/L, high-density lipoprotein (HDL) 55 mg/dL, low-density lipoprotein (LDL) 135 mg/dL, and triglycerides: 114 mg/dL.On physical exam there is confluent erythematous patches with tiny vesicles and scaling. on close inspection. His mother notes that he has been bathing the patient at least twice a day. Of the following, what advice do you give?

A - Usually, scabs with a distinctive yellow, gold, or brown crust are seen.
B - Hot baths that are too long, or too frequent, can dry out the skin.
C - This condition is caused by the herpes simplex virus
D - You can expect blisters, fever and large areas of skin that peel or fall away.
E - This condition is usually seen on the scalp, face, ears, and neck.
 
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* Re:answer for this Archer question
#3323078
  aravindk - 01/05/17 22:44
 
  ??  
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* Re:answer for this Archer question
#3323175
  heartlocker - 01/06/17 15:55
 
  D?
Erysipelas (painful rash/RBCs in urine)
 
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* Re:answer for this Archer question
#3323265
  aravindk - 01/07/17 16:02
 
  not erysipelas  
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* Re:answer for this Archer question
#3323270
  aravindk - 01/07/17 17:02
 
 
A – Incorrect. Impetigo causes red bumps on the skin, usually on the face, arms, or legs. These bumps eventually form blisters that then burst and scab over with a distinctive yellow, gold, or brown crust.
C – Incorrect. Eczema herpeticum presents as disseminated vesiculopustules and erosions caused by the herpes simplex virus that occur at sites of existing skin damage such as atopic dermatitis, eczema, or burns.
D – Incorrect. While scalded skin syndrome is found most commonly in children under 5 years of age, it is characterized by blisters, fever and large areas of skin that peel or fall away. It is caused by infection with certain strains of Staphylococcus bacteria.
E – Incorrect. Seborrheic dermatitis does not usually present with pruritus and is less likely to affect the trunk, and more likely to affect the scalp, face, ears, neck or diaper area.

Atopic dermatitis affects approximately 11% of children in the United States. [1] In 60% of cases, atopic dermatitis presents in the child’s first year. [2] Pruritus is common and infants may present with scaly, red and crusted lesions. Acute lesions can include vesicles.
While lukewarm baths hydrate the skin, hot baths that are too long, or too frequent, can dry out the skin. Baths should be warm, and last no longer than 10 minutes. Mild soap or a nonsoap cleanser should be used sparingly and a moisturizer containing ceramide should be applied immediately after bathing.

References:
1. Shaw T, Currie G, Koudelka C, Simpson E. Eczema prevalence in the United States: data from the 2003 National Survey of Children's Health. J Invest Dermatol 2011; 131:67.
2. Williams H. Clinical practice. Atopic dermatitis. N Engl J Med 2005; 352:2314.
 
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* Re:answer for this Archer question
#3323636
  hesslid - 01/10/17 16:24
 
  Thank you for qestion  
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* Re:answer for this Archer question
#3323926
  aravindk - 01/12/17 23:57
 
  very welcome hessild  
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* Re:answer for this Archer question
#3324136
  chenna - 01/14/17 12:57
 
  this is a nice qn. Thank you  
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