Pediatric Examination and Board Review (31 page)

S
UGGESTED
R
EADING

Arieff AI. Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women.
N Engl J Med.
1986;314(24):1530-1534.

Ayus JC, Krothapalli RK, Arieff AI. Treatment of symptomatic hyponatremia and its relation to brain damage.
N Engl J Med.
1987;317(19):1190-1195.

Keating JP, Schears GJ, Dodge PR. Oral water intoxication in infants. an American epidemic.
Am J Dis Child.
1992;145(9): 985-990.

Sterns RH, Riggs JE, Schoechet SS Jr. Osmotic demyelination syndrome following correction of hyponatremia.
N Engl J Med.
1986;14(24):1335-1341.

Chapter 3

DERMATOLOGY

CASE 16: A NEONATE WITH A BIRTHMARK ON THE FACE

A girl of 30 weeks’ gestation is noted shortly after birth to have a red patch on the left face. The patch involves the left forehead, extending onto the scalp, and onto the left upper eyelid. Initially the lesion is flat and partially blanching. Over the subsequent 2-3 weeks the patch becomes more raised, with a pebbly surface. It is noted that the left eye is not as wide open as the right (
Figure 16-1
).

SELECT THE ONE BEST ANSWER

1.
What is the most likely diagnosis?

(A) hemangioma

(B) port wine stain

(C) capillary malformation

(D) angiosarcoma

(E) nevus sebaceous

2.
What syndrome might be associated with this lesion?

(A) Sturge-Weber syndrome

(B) Klippel-Trenaunay syndrome

(C) A neurofibromatosis syndrome

(D) Tuberous sclerosis syndrome

(E) PHACE syndrome

3.
The imaging study most likely to support a diagnosis of this syndrome?

(A) magnetic resonance imaging (MRI) of the spine

(B) MRI of the head

(C) renal ultrasound

(D) electrocardiogram (ECG)

(E) spinal ultrasound

4.
The most appropriate management of this lesion includes

(A) observation

(B) systemic corticosteroids

(C) phenobarbital

(D) laser therapy

(E) interferon alpha

5.
You educate the parents to expect that this lesion will

(A) be gone by 2 years of age

(B) remain stable in size and appearance through childhood

(C) gradually flatten and fade through childhood

(D) require surgical excision

(E) carry a risk for malignant degeneration over the lifetime of the patient

6.
The parents report that this child’s cousin has a hairless plaque in the scalp with a pebbly surface and orange hue (
Figure 16-2
). You are concerned that the child’s cousin might have an increased risk for

(A) melanoma

(B) basal cell carcinoma

(C) tinea capitis

(D) alopecia areata

(E) tethered spinal cord

7.
An 8-year-old boy presents for evaluation of a birthmark on the abdomen (
Figure 16-3
). You recommend

(A) immediate excision

(B) cryotherapy

(C) radiographic examination

(D) laser therapy

(E) observation

FIGURE 16-1.
See color plates.

8.
At a newborn’s 1-month follow-up appointment the parents note a lesion on the child’s back that has occasionally appeared raised and fluid filled (
Figure 16-4
). A helpful examination technique is

(A) firm stroking of the lesion

(B) palpation for a thrill

(C) diascopy

(D) transillumination

(E) potassium hydroxide (KOH) prep

FIGURE 16-2
.
See color plates.

FIGURE 16-3
.
See color plates.

9.
Based on your findings, you prescribe

(A) hydrocortisone ointment

(B) hydroxyzine suspension

(C) permethrin cream

(D) excision

(E) acyclovir suspension

10.
One month later, the child presents with multiple tan brown plaques, some with a thickened surface, over the trunk and extremities (
Figure 16-5
). You inform the parents

(A) the child needs a bone marrow biopsy

(B) the child needs a bone marrow transplant

(C) these lesions will fade and resolve by 10-12 years of age

(D) the child has neurofibromatosis

(E) the child needs a rapid plasma reagin (RPR)

FIGURE 16-4.
See color plates.