A 2-day-old male newborn is evaluated in the hospital nursery for a newly developed skin r… — USMLE Step 2 CK

A $2$ -day-old male newborn is evaluated in the hospital nursery for a newly developed skin rash. He was born at $39$ weeks gestation via uncomplicated vaginal delivery to a $28$ -year-old mother who had comprehensive and normal prenatal care. The infant is breastfeeding well and has normal bowel and bladder output. His temperature is $37.0^\circ\text{C}$ ( $98.6^\circ\text{F}$ ), heart rate is $130/\text{min}$ , and respiratory rate is $40/\text{min}$ . Physical examination reveals a well-appearing, alert neonate. There are multiple splotchy, erythematous macules, several of which have central $1$ - to $2$ -mm yellow-white pustules, scattered across his chest, back, and proximal thighs. The palms and soles are completely spared. The remainder of the physical examination is unremarkable. Which of the following is the most appropriate next step in management?

Reassurance and observationCevap
B
Intravenous acyclovir
C
Intravenous ampicillin and gentamicin
D
Topical mupirocin
E
Skin scraping for potassium hydroxide preparation

Cevap

The most appropriate next step in management is reassurance and observation.

The correct management is reassurance and observation because the infant's presentation is highly characteristic of erythema toxicum neonatorum (ETN). ETN is a very common, benign, asymptomatic rash that typically appears in full-term neonates between days

2

and

3

of life. It is classically described as having a 'flea-bitten' appearance consisting of erythematous macules with central

1

- to

2

-mm papules or pustules. The rash usually involves the trunk and proximal extremities but characteristically spares the palms and soles. Because the newborn is otherwise well-appearing, afebrile, and feeding normally, no diagnostic testing or pharmacologic intervention is indicated. The rash will spontaneously fade over the next week.

Adım Adım Çözüm

Evaluate the patient's clinical status and vital signs.

The infant is afebrile, feeding well, and has normal vital signs for his age.

Differentiating between benign and infectious rashes in a neonate relies heavily on whether the infant is well-appearing or exhibits signs of systemic illness (e.g., fever, lethargy).

Characterize the rash.

The rash consists of erythematous macules with central yellow-white pustules on the trunk and proximal extremities, sparing the palms and soles.

This classic 'flea-bitten' appearance appearing at

24

72

hours of life is the hallmark of erythema toxicum neonatorum.

Determine the appropriate management.

Select reassurance and observation.

Erythema toxicum neonatorum is a benign, transient condition that resolves spontaneously within a week without any specific diagnostic testing or treatment.

Anahtar Kavram

Erythema toxicum neonatorum is a common, benign, self-limited rash in healthy newborns that presents as erythematous macules with central papules/pustules and requires only reassurance.

Soru

Cevap

Adım Adım Çözüm

Anahtar Kavram

Sık Yapılan Hatalar

Konular

Bu konudan daha fazla soru