FP Essentials

Cutaneous lupus erythematosus (CLE) is a spectrum of autoimmune skin conditions associated with systemic lupus erythematosus (SLE). CLE and SLE may exist concurrently or independently. Accurate recognition of CLE is crucial because it may herald systemic disease onset. Lupus-specific skin conditions include acute cutaneous lupus erythematosus (ACLE) which manifests as a malar or butterfly rash; subacute cutaneous lupus erythematosus (SCLE); and chronic cutaneous lupus erythematosus, which includes discoid lupus erythematosus (DLE)...

Systemic sclerosis (formerly scleroderma) is a relatively rare autoimmune connective tissue disease which symmetrically affects the skin and affects the internal organs. There are two types: limited cutaneous and diffuse cutaneous. Each type is categorized by different clinical, systemic, and serologic findings. Autoantibodies can be used to predict phenotype and internal organ involvement. Systemic sclerosis can affect the lungs, gastrointestinal system, kidneys, and heart. Pulmonary and cardiac disease are the leading causes of death, so screening for these conditions is important...

There are many types of autoimmune blistering skin disease. Two of the most common are bullous pemphigoid and pemphigus vulgaris. Bullous pemphigoid is characterized by tense bullae created by a subepidermal split resulting from autoantibodies targeted at the hemidesmosomes at the dermal-epidermal junction. Bullous pemphigoid typically occurs in elderly people and often can be drug-induced. Pemphigus vulgaris is characterized by flaccid bullae because of an intraepithelial split triggered by autoantibodies targeting desmosomes...

Psoriasis is a chronic, inflammatory skin condition with significant effect on quality of life. It affects 3.2% of the United States population. Psoriasis is caused by an interaction between genetic and environmental triggers. Associated conditions include depression, increased cardiovascular risk, hypertension, hyperlipidemia, diabetes, nonalcoholic fatty liver disease, Crohn disease, ulcerative colitis, celiac disease, nonmelanoma skin cancers, and lymphoma. Several clinical variants exist, including chronic plaque, guttate, pustular, inverse, and erythrodermic psoriasis...

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Patients at increased risk of stillbirth should be assessed with antepartum fetal surveillance (AFS) tests at regular intervals. In general, AFS should begin at the gestational age at which delivery would be considered. Most surveillance tests are performed weekly, but more frequent testing should be considered for patients with high-risk conditions. AFS tests include fetal movement monitoring, nonstress test, contraction stress test, biophysical profile, and modified biophysical profile. Umbilical artery Doppler velocimetry is used in the setting of fetal growth restriction...

Fetal growth restriction (FGR) is defined as an ultrasound (US)-determined estimated fetal weight or abdominal circumference less than the 10th percentile according to a population level reference curve. FGR affects up to 10% of pregnancies. Fetuses with FGR are at increased risk of intrauterine mortality and, postnatally, neonatal intraventricular hemorrhage, necrotizing enterocolitis, respiratory distress, hypoglycemia, and suboptimal neurologic, behavioral, and cognitive development. In early-onset FGR (ie, less than 32 weeks' gestation), a detailed US examination is recommended...

Two screening approaches are used to detect gestational diabetes, the 1-step and 2-step methods. The 1-step method is diagnostic and consists of a 75-g, 2-hour oral glucose tolerance test (OGTT). The 2-step method consists of a 50-g, 1-hour glucose challenge test, followed by a 100-g, 3-hr OGTT if initial test results are positive. All pregnant patients should be screened for gestational diabetes between 24 and 28 weeks' gestation unless pregestational diabetes is present. Lifestyle modifications are fundamental to management, and most patients are able to control blood glucose levels with these alone...

Vaginal bleeding in the first trimester is a common concern during pregnancy. The amount of bleeding and associated symptoms, such as nausea and vomiting, can be of prognostic value. Timely evaluation with vital signs, physical examination, laboratory tests (eg, Rh factor, hemoglobin and possibly progesterone levels), and pelvic ultrasound (US) can distinguish among viable pregnancy, nonviable pregnancy, intrauterine pregnancy (IUP) of uncertain viability, and pregnancy of unknown location. Serial pelvic US can be obtained in patients with IUP of uncertain viability after 11 to 14 days, and in pregnancy of unknown location in as little as 48 hours...

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Third-party fertility treatments refer to use of egg donors, sperm donors, donated embryos, and/or third-party gestational carriers/surrogates to have a child. There are two main categories of fertility treatments: intrauterine insemination (IUI) and in vitro fertilization (IVF). IUI involves placement of sperm (from a donor or from the woman's partner) into a woman's uterus. In IVF, egg production is stimulated with drugs, after which the eggs are vaginally retrieved, fertilized with sperm in a laboratory, and then transferred into a uterus (of the intended parent or a gestational carrier) or cryopreserved for future use...

Nuclear families (consisting of a married man and woman and their children) have long been regarded as the default domestic arrangement. Nonetheless, there are many other family structures that are becoming increasingly more common and complex. Single-parent families can result from divorce or the death of one parent, or may be intentionally planned before conception. Multigenerational families typically include children, parents, and grandparents living together, although sometimes parents are absent and grandparents are the caregivers...

Approximately 29% of LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual/agender, and other orientations/identities) adults are raising a child, and 2 to 3.7 million children have an LGBTQIA+ parent. These families often experience challenges. Social challenges include exclusion and homophobic hostility directed at the child and/or family. Medical challenges include difficulty finding clinicians who provide a welcoming environment, and dealing with clinicians who do not understand LGBTQIA+ issues...

Foster care is a service for children who cannot live with their families. There are many reasons for foster care, the most common of which is parental neglect and/or substance abuse. At any one time, more than 400,000 US children are in foster care. Although 59% are eventually reunited with their parents, some end up in other situations, including adoption. Children should undergo a physician evaluation within 72 hours of entering foster care, a comprehensive evaluation within 30 days, and a follow-up visit within 60 to 90 days, followed by routine care...

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Abnormal head shape and size often are apparent in infancy and typically are noted by caregivers or by clinicians on physical examination. Positional plagiocephaly consists of deformation of the skull not associated with an underlying skull fusion abnormality. This should be differentiated from craniosynostosis, which is the premature fusion of one or more skull sutures. For patients with craniosynostosis, early referral to a pediatric neurosurgeon or craniofacial specialist is important to prevent continued skull deformity and decrease the risk of increased intracranial pressure due to reduced skull adherence and obstruction of cerebrospinal fluid flow...

Most movement disorders in children are hyperkinetic. The most common type is tic disorders, which can involve motor and phonic tics and are classified as simple or complex. Motor or phonic tics that persist for more than 1 year are defined as persistent (chronic) tic disorder. Tourette syndrome can be diagnosed if a child has multiple motor tics and at least one phonic tic for more than 1 year with onset before age 18 years. Children with Tourette syndrome may have symptoms of attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, depression, or behavioral disorders...

Epilepsy is the most common neurologic condition in children and is characterized by recurrent unprovoked seizures. Epilepsy can be diagnosed after a first unprovoked seizure if characteristic clinical and electroencephalographic features suggest a high risk of future seizures. Epilepsy is classified based on seizure type, underlying causes, and potential electroclinical syndromes. This classification guides management and predicts its effectiveness. Some epilepsy syndromes resolve spontaneously (ie, are self-limited) or improve with management (ie, are pharmacoresponsive)...

Seizure is one of the most common neurologic conditions in children, occurring most often in the first year of life. Identification of provoking factors, such as fever, illness, head trauma, electrolyte disturbance, or central nervous system infection, is important for determining prognosis and likelihood of recurrence. In patients presenting with a suspected first seizure, a history should be taken and a neurologic examination performed to determine whether the event was a seizure. If seizure is confirmed, it should be determined whether it was a first seizure and was provoked or unprovoked...

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