A young mother brings in her 3-year-old daughter to the clinic because of worsening acne problems on her daughter's face. She had a normal birth without complications. However, she is developmentally slow and has had a few episodes of seizures of unknown etiology. Her medications include phenytoin and a multivitamin. The child is playful and her size and weight are appropriate for her age. She has numerous firm, flesh-colored papules scatter over her nose, both cheeks, and chin. There are no pustules or inflammatory papules. She also has multiple, small, hypopigmented ash leaf and confetti-type macules on both lower extremities. The rest of her examination is unremarkable. The next most appropriate step is to
A. check morning level of cortisol
B. check serum level of DHEAS and testosterone
C. prescribe oral minocycline
D. prescribe topical benzoyl peroxide every morning and topical erythromycin every evening
E. send her for an x-ray of the skull
Kap q ___________________ The Key to Succeed is Patience.
DrVirgo Forum Hero
Topics: 1096 Posts: 3,515
06/11/07 - 02:17 PM
#2
ash leaf spots = Tuberous Sclerosis diagnosed by CT or MRI of the head
??? closest answer is E?
___________________ Our greatest glory is not in never falling, but in rising every time we fall.
yasmeen Forum Guru
Topics: 68 Posts: 940
06/11/07 - 04:22 PM
#3
C?
khorshid Forum Guru
Topics: 32 Posts: 591
06/11/07 - 05:46 PM
#4
E (Tuberous sclerosis, )acne in this age is meaningless, unless there is precocious puberty?)But I agree that skull xray is not the best initial test, however I don't remember any associations with cortisol or DHEAS...?!
prasannakumar Forum Senior
Topics: 24 Posts: 55
06/12/07 - 12:11 PM
#5
E..x-Ray skull may show calcified tubers.But head CT is more diagnostic. I think adenoma sebaceum are described here as acne
cirus Forum Guru
Topics: 108 Posts: 740
06/12/07 - 01:52 PM
#6
tuberous sclerosis from the face rash is typical of sebaceous adenomas ( small red nodules on nose & cheek), ash leaf rash on ext...
The ct scan shows periventricular calcified tubers...so ill go with E (the X ray will show the calific)
But Tuberous sclerosis is also very commanly associated with infantile spasm so getting a morning cortisol level will help definetly help, what do u think
DrVirgo Forum Hero
Topics: 1096 Posts: 3,515
06/13/07 - 08:26 AM
#7
whats the right answer robin? ___________________ Our greatest glory is not in never falling, but in rising every time we fall.
robin082006 Forum Hero
Topics: 471 Posts: 5,123
06/13/07 - 10:25 AM
#8
DrVirgo wrote: ash leaf spots = Tuberous Sclerosis diagnosed by CT or MRI of the head
??? closest answer is E?
Correct,
Answer IS e
this is Tuberous Sclerosis: seisure, cafe au alt, sebaceous adenoma
Xray of skull to see calcification. ___________________ The Key to Succeed is Patience.
DrVirgo Forum Hero
Topics: 1096 Posts: 3,515
06/13/07 - 10:26 AM
#9
Yeeaa!!!
robin082006 wrote: Correct,Answer IS ethis is Tuberous Sclerosis: seisure, cafe au alt, sebaceous adenomaXray of skull to see calcification.
___________________ Our greatest glory is not in never falling, but in rising every time we fall.
