Concise, precise advice from my colleagues means learning directly from others’ experience, and that’s the source of this week’s clinical pearl.
Dr. Joshua Landy
Co-founder, Figure 1
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1. Prior-season influenza vaccination is not associated with reduced vaccine effectiveness — reinforcing the need for annual flu shots. JAMA Open, October 2018
2. Ultrasound-guided techniques reduced the odds of central venous cannulation failure by almost 75% when compared to the anatomic landmark technique. Pediatrics, October 2018
3. Fetal exposure to tobacco smoke may advance timing of puberty in boys and girls. American Journal of Epidemiology, October 2018
4. Maternal voice smoke alarms were three times more likely to wake a child than standard tone alarms — but the inclusion of the child’s name in the alarm had no discernible effect. Journal of Pediatrics, October 16, 2018
5. From 2007 to 2015, rates of CT neuroimaging for pediatric head trauma ED visits remained constant, suggesting a need for initiatives to ensure appropriate CT use in this population. Pediatrics, October 2018
A 17-year-old male presents with a one-year history of a recurrent pruritic rash on his back, shoulders, hands, and axillae. He mentions that the rash is typically worse in the summer months and similar in appearance to one his mother has. Examination reveals numerous brown keratotic papules with a greasy texture and multiple cobblestone lesions in the mouth. A skin biopsy demonstrates a dermal inflammatory process, with acantholysis at all epidermal levels, as well as significant dyskeratosis. Which of the following other clinical features is consistent with this patient’s most likely diagnosis?
B. Red and white nail bands
Answer at the bottom of this post, or click here to see the full case and discussion on Figure 1, a free physician community for viewing medical cases.
This week’s pearl comes from a pediatrician on Figure 1 who shared a strategy for counselling the parent of an obese child:
My best advice is to suggest something extremely simple that makes a difference over time and cuts 200-300 cal/day: Starting at that moment, if it’s not water, they don’t drink it. No juice, no soda, no sports drinks, even no milk — or at most 16oz/day skim milk. I explain that what I am saying is not the same as “drink a lot of water,” it’s, if it’s NOT water, they don’t drink it.
CLINICAL QUIZ ANSWER:
C. Red and white nail bands
This patient’s presentation and biopsy results are indicative of Darier disease (keratosis follicularis), a rare genetic skin disorder. The condition is characterized by greasy hyperkeratotic papules in seborrheic areas, mucosal changes, and nail abnormalities. Although several different types of fingernail findings can be seen in the condition, a combination of white and red longitudinal bands and a V-shaped nick at the free margin of the fingernail is a pathognomonic finding.
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