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Illness Scripts Flashcards

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1
Q

Functional Constipation

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing condition:

Usually occurs around toilet training, related to a painful bowel movement

  1. Pathophysiologic Insult/ Common Cause:

Inciting event leads to stool retention, followed by rectal/colon dilation, then failure of the rectum to generate pressure to have a bowel movement or sense a bowel movement

  1. Clinical Manifestions:

Abdominal pain/distention, stool in rectal vault, fecal incontinence, stool on KUB ( not always needed for diagnosis)

  1. Dx: Usually diagnosed by history and exam but can use KUB
  2. Tx: Diet changes, consider stool softeners and laxitives. We typically use miralax
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2
Q

Henoch Schonlein Purpura

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing condition:

Peaks around 4-6 yrs of age

  1. Pathophysiologic Insult/ Common Cause:

Small vessel vascultis related to IgA deposition, neutrophils and monocytes

  1. Clinical Manifestions:

RASH: symmetric, appear in crops, usually on lower extremities and in pressure dependent areas,

range from erythematous macular wheels that coalesce and evolve into ecchymoses, can have petechia and purpura

ARTHRALGIAS: transient, migratory, large lower extremity joints, edematous but not erythematous

ABD PAIN: hematochezia, intussusception

RENAL DZ: hematuria, hypertension, proteinuria-renal disease is a late finding

Labs: CBC should be normal in the face of petechia/purpura

  1. Dx: Diagnosed by history and exam
  2. Tx: SUPPORTIVE care, sometimes steroids are needed for severe abdominal pain or renal involvement but this is controversial
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3
Q

Intussusception

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing condition:
    • 3 mos to 6 yrs of age
    • 75% are idiopathic
    • Possibly caused by preceding viral illness such as adenovirus
  1. Pathophysiologic Insult/ Common Cause:

Periodic telescoping of the bowel due to a “lead point”

With telescoping, the messentary is also drawn in and obstructs vessels causing swelling and then bowel gets stuck, losing blood supply

Most common pathologic lead point is a MECKELS diverticulum

  1. Clinical Manifestations:
    • Intermittent abdominal pain, occurring every 15-20 minutes
    • Drawing up legs with episodes
    • Vomiting, may be bilious
    • Sausage shape mass in the RLQ
    • Currant jelly stool

Ultrasound: target sign

KUB: distended loops with no colonic gas

  1. Dx: Diagnosed by ULTRASOUND
  2. Tx: air enema, if unable to reduce then proceed to surgical reduction
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4
Q

Peptic Ulcer Disease (PUD)

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing condition:

Steroids, NSAIDS, Stress, H. Pylori

  1. Pathophysiologic insult/ Common Cause:
    • Defect in gastric or duodenal mucosa
    • NSAIDS inhibit cox 1 which decreases prostaglandins which protect stomach
    • H. Pylori possibly increases stomach acid secretion
  1. Clinical Manifestations:

Epigastric pain, GERD, nausea, fullness, melena, hematochezia, endoscopy shows erosions

4 Dx: History and exam findings and SCOPE

  1. Tx: Dietary/life style changes, PPI, possibly carafate
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5
Q

Crohns Dz and Ulcerative Collitis

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing condition:

Late childhood and adolescence

  1. Pathophysiologic insult/ Common Cause:
    * not understood* :) one less thing to memorize girl
  2. Clinical Manifestations:

CROHNS:

    • bx-TRANSMURAL inflammation with granulomas,
    • colonoscopy = cobblestoning and SKIP lesions,
    • inflammation is anywhere along digestive tract but focuses on ILEUM/ILEOCECAL, rectal sparing,
    • can have perianal disease and fistulas

ULCERATIVE COLITIS:

    • bx = MUCOSAL/SUBMUCOSA inflammation with CRYPT abscesses and crepitates
    • colonoscopy = CONTINUOUS inflammation from COLON TO RECTUM, no skip lesions
    • Toxic megacolon can be complication

Findings for BOTH: abdominal pain, weight loss, elevated crp/esr, rectal bleeding, diarrhea, poor growth

  1. Dx: Scope with bx
  2. Tx: Immune suppression
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6
Q

Pancreatitis

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing condition: Family hx, gall stones, preceding viral illness, medications, systemic diseases, metabolic disorders, abnormal anatomy of pancreas
  2. Pathophysiologic insult/ Common Cause:
    - - idiopathic
    - - galls stones obstruct common bile duct
    - - if hereditary it can be autoimmune
  3. Clinical Manifestations:
    - - epigastric pain, may radiate to back or have diffuse abdominal pain
    - - amylase and lipase are elevated
    - - if gallstone is the etiology you may have elevated bilirubin and LFTs
  4. Dx: Elevated, amylase and lipase, ULTRASOUND shows pancreatitis
  5. Tx: pain control, diet restriction as tolerated, remove inciting cause if able such as a gall stone
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7
Q

Appendicitis

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing condition:

More common in children >10 yoa and peaks in adolescence

  1. Pathophysiologic insult/ Common Cause:

Appendix gets obstructed, leading to bacterial overgrowth and infection

  1. Clinical Manifestations:
    • Periumbilical pain progressing to RLQ pain
    • Rovsings sign, Obturator sign and Iliopsoas Sign,
    • rebound tenderness with guarding
    • younger children may have non specific signs
    • pts may have fever, elevated WBC and CRP
  1. Dx: CT of abdomen/pelvis or ultrasound
  2. Tx: Surgical
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8
Q

Cholecystitis

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing condition:

Hemoglobinopathies, Cystic Fibrosis

  1. Pathophysiologic insult/ Common Cause:

Cystic duct obstruction leads to inflammatory process

  1. Clinical Manifestations:
    • RUQ pain, can radiate to shoulder, worse after fatty foods, + murphy’s sign
    • ultrasound shows edematous gall bladder
    • HIDA scan shows decreased function
  1. Dx: Hida scan, ULTRASOUND
  2. Tx: Surgical
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9
Q

Ovarian Torsion

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing condition:

Can occur at any age but most common after start of menstruation, Ovarian cyst or mass can be inciting factor

  1. Pathophysiologic insult/ Common Cause:

rotation of INFUNDIBULOPELVIC LIGAMENT which houses OVARIAN VESSELS; flow is obstructed when twisted

  1. Clinical Manifestation:

– Moderate to severe pelvic pain that radiates to the flank, back, groin and is described as sharp, stabbing, colicky, cramping,

– may have adenexal mass on manual exam,

– Pelvic/transvaginal u/s with doppler shows decreased or absent flow

  1. Dx: Pelvic ultrasound with doppler
  2. Tx: Surgical
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10
Q

Pelvic Inflammatory Disease

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing condition:

Sexually active, hx of unprotected sex, multiple partners, hx of STI or STI in partner

  1. Pathophysiologic insult/ Common Cause:

Endocervical infection weakens the barrier and ascends up GU tract

  1. Clinical Manifestation:

bilateral pelvic and lower abdominal pain, less then 2 weeks in duration, abnormal discharge, friable cervix, cervical motion tenderness

  1. Dx: Culture or urine chlamydia and gonorrhea PCR
  2. Tx: Ceftriaxone for gonorrhea and azithromycin for chlamydia , tx varies
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11
Q

Malrotation/Volvulus

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing Condition:

Usually <1y.o.a. and associated with other GI anomalies

  1. Pathophysiologic insult/ Common Causes:

Arrest of normal rotation of the gut, narrow mesenteric base which leads to increased mobility, may have lads bands, volvulus is when the small bowel twists around the superior mesenteric artery

  1. Clinical Manifestations:

Vomiting +/- bilious, abdominal distension and tenderness, upper GI shows a misplaced duodenum with corkscrew appearance

  1. Dx: Upper GI
  2. Tx: Surgical
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12
Q

Incarcerated Hernia

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing Condition:

Typically right sided, girls> boys, usually <1y.o.a.

  1. Pathophysiologic insult/ Common Cause:

Processus vaginalis is patent, bowel goes through internal ring

  1. Clinical Manifestations:

Irritable, crying, may have firm/discrete inguinal mass extending into scrotum/labia, may be tender to palpation

  1. Dx: Ultrasound
  2. Tx: Surgical
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13
Q

Testicular Torsion

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing Condition:

Increased incidence in the neonatal period and after puberty

  1. Pathophysiologic insult/ Common Cause:
    • Teste is not attached to the tunica vaginalis(bell clapper deformity)
    • often bilateral, enables twisting of spermatic chord (contains blood supply)
  1. Clinical Manifestations:

Abrupt onset of scrotal/testicular pain radiating to the groin/abdomen, edematous and tender teste, pain increases with elevation, no cremasteric reflex, Ultrasound shows twisting of chord, decreased or no blood supply

  1. Dx: ULTRASOUND with DOPPLER
  2. Tx: Surgical
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14
Q

Urinary Tract Infection

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing Condition:

More frequent in boys <1y.o.a. and girls < 4 y.o.a., uncircumcised increases risk, urinary obstruction, neurogenic bladder, constipation, sexual activity, vesico-ureteral reflux

  1. Pathophysiologic insult/ Common Cause:

Ecoli is the most common cause, staph saprophyticus for sexually active

  1. Clinical Manifestations:

<2y.o.a.: temp>40c = 104f, suprapubic tenderness, poor feeding, fussy, maybe no other source of fever

> 2y.o.a.: fever, dysuria, increased frequency, incontinence, abdominal/flank pain, chills

Lab: urine culture: cath: >50,000 cfu,
clean catch: >100,000 cfu

  1. Dx: Urine CULTURE
  2. Tx: abx coverage for ecoli, adjust depending on scenario
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15
Q

Asthma

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing Condition:

Allergies ,Eczema, Family history (1 parent increases risk by 2x and 2 parents by 5x)

  1. Pathophysiological insult/ Common Cause:

Acute phase: Allergen attaches to IgE and causes mast cell to release histamines, prostaglandins and leukotrienes which causes contraction of the smooth muscle.

Late phase: inflammation caused by eosinophils, neutrophils, basophils and helper/memory t cells, this also causes smooth muscle contraction

**smooth muscle contraction causes bronchial constriction

  1. Clinical Manifestation:
    • coughing (can occur night or day or both), wheezing
    • prolonged expiratory phase, retractions, decreased air entry
    • **air movement, wheezing and tightness improve with beta agonist therapy
    • if old enough, decreased PFTS, (>5y.o.a.)
  1. Dx by history and exam, evaluating before and after albuterol, use PFTS.
    Depending on frequency of symptoms you classify asthma as intermittent, mild persistent, moderate persistent and severe)
  2. Tx:

Albuterol: smooth muscle relaxer, enables bronchiol dilation (do this first), Steroids(inhaled, IV or oral) decrease inflammation, depending on severity use epi, magnesium etc

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16
Q

Bronchiolitis

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing Condition:

Late fall, winter, Less than 2 years of age

  1. Pathophysiologic insult/ Common Cause:
    • Caused by RSV, can be other viruses.
    • Infect terminal bronchiolar epithelial cells, causing inflammation, edema and mucous
    • Sloughed cells cause obstruction and atelectasis of small airways, cell necrosis, ciliary disruption and peribronchiolar lymphocytic infiltration occurs.
  1. Clinical Manifestation:

cough, congestion, wheeze, retractions, prolonged expiratory phase, rales (crackles) that change in location, apnea in premature infants or children less than 2 mos of age

  1. Dx:

Rapid antigen testing, viral PCR

  1. Tx:

Supportive care, suctioning, iv fluids, hypertonic saline, typically albuterol, steroids and abx are NOT warranted

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17
Q

Chlamydial Pneumonia

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing Condition:

infants 4-12 weeks of age, vaginal delivery

  1. Pathophysiological insult/ Common Cause:

chlamydia is contracted as the baby passes through the vaginal canal

  1. Clinical Manifestation:
    • upper respiratory tract infection symptoms, cough and congestion
    • stacatto cough may occur in paroxysms , rales, wheezing is uncommon
    • wbc is usually normal, eosinophilia can be present
  1. Dx: Culture is the gold standard
  2. Tx: Azithromycin or Erythromycin
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18
Q

Community Acquired Pneumonia

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing Condition:

Viral URI

  1. Pathophysiological insult/ Common Causes:
    • URI causes weakness in defenses
    • staph aureus and strep pneumo are the most common and are droplet spread, they infect the nasopharynx and then the lower respiratory tract,
    • wbc’s, fluid and cell debris accumulate in the lungs, decrease lung compliance and ventilation
  1. Clinical Manisfestations:
    • no specific symptoms associated with pneumonia
    • tachypnea has the highest association with pneumonia
    • can also have fever, cough, increased work of breathing, egophony and bronchophony (99), dullness to precussion, splinting, crackles (rales) in one location
    • Xray shows a lobar consolidation
  1. Dx: Exam and history, may dx with chest x-ray
  2. Tx: Amoxicillin for outpatient, Ampicillin for inpatient
    * if a complicated pneumonia or atypical pneumonia the treatment varies
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19
Q

Cystic fibrosis

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing Condition:

CFTR gene mutation, Parents are carriers, Whites are at highest risk

  1. Pathophysiological insult/ Common Cause:
    • Mutations in the CFTR gene (Cystic Fibrosis Transmembrane Conductance Regulator Protein)
    • causes decreased transport of sodium, bicarbonate and chloride
    • causing increased viscosity of secretions in the lungs, pancreas, liver, intestines and reproductive tract
    • also causes increased NaCl secretion in sweat
  1. Clinical Manifestations:

RESPIRATORY: may have sinusitis and nasal polyps, persistent cough, hyperinflation of lungs on X-ray, decreased PFTS showing obstructive disease. Infants may show persistent cough, wheeze, difficulty breathing

GI: pancreatic insufficiency leading to fat malabsorption and failure to thrive and steatorrhea. Vitamins K,A,D,E are not absorbed well (fat soluble)

Newborns may have a MECONIUm ILEUS, 80-90% of patients with Mec. Ileus will have CF, FTT in young patients

ENDOCRINE: late diabetes

  1. Dx:
    - - Gene testing for the CFTR mutation assay,
    - - newborns can have the IRT Assay which is a test for immuno reactive trypsinogen which is high in the new born period.
    - - Sweat Cholide test
  2. Tx: Supportive
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20
Q

Croup

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing Condition:
    • 6 - 36 monthss of age
    • fall/early winter
    • anatomic airway abnormalities, history of difficult intubation
  1. Pathophysiological insult/ Common Cause:

Parainfluenza infects the nasopharynx and spreads to the larynx and trachea, causing subglottic tracheal narrowing and mucosal edema

  1. Clinical Manifestations:
    • Runny nose, cough, congestion, “barky cough”,
    • inspiratory stridor at rest or with activity, (at rest is more concerning)
    • increased work of breathing
    • steeple sign on x-ray
  1. Dx: Exam
  2. Tx:
    • Racemic epi to decrease stridor and respiratory distress
    • Decadron (a steroid) to decrease inflammation, stays in system for 48hrs
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21
Q

GERD

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing Condition:
    • Usually patients <1yoa
    • Children with developmental or neuromuscular disorders
  1. Pathophysiological insult/ Common Cause:

Stomach contents travel retrograde into the esophagus due to a weakened LES

  1. Clinical Manifestation:
    • Symptoms typically resolve by 1 year of age, Back arching, spitting up, fussiness
    • SANDIFER syndrome(stiffen, arch back, turn head, confused with sz), FTT
    • Rectal bleeding (due to food protein induced proctocolitis (inflammation of rectum and colon)…milk)
    • Apnea….ALTE (apparent life-threatening event)

– (older patients: epigastric pain, regurgitation, nausea, cough)

  1. Dx: by history and exam, could use Upper Gi but not needed
  2. Tx: H2 blocker or PPI, thicken feeds, positioning of baby

**Only treat when symptomatic, tx using medication does not stop spitting up but makes it tolerable due to decreasing acidity

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22
Q

Laryngomalacia

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing Condition:

Some patients may be HYPOTONIC or have underlying NEUROMUSCULAR DZ, common in the neonatal period without other issues

  1. Pathophysiological insult/ Common Cause:
    - - collapse of supraglottic structures during inspiration
  2. Clinical Manifestation:
    - - Low pitched inspiratory stridor, loudest at 4-8 months, worse in the supine position and improves in the prone position.
    - - May increase in sound with eating, sleeping or when patient has a URI
  3. Dx: History or flex larnygoscopy
  4. Tx: Usually no treatment, patient grows out of it, can do supraglottoplasty
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23
Q

Trachealmalacia

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing Condition:
    none
  2. Pathophysiological insult/ Common Cause:

– collapse of trachea during expiration due to poor cartilage formation

  1. Clinical Manifestation:

recurrent harsh or barky croup like cough

  1. Dx: Bronchoscopy or Fluoroscopy
  2. Tx: Usually no treatment, patient grows out of it, can do surgery if severe
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24
Q

Pertussis

  1. Predisposing Condition
  2. Pathophysiologic Insult/ Common causes
  3. Clinical Manifestations
    ________________________
    not part of traditional illness script
  4. Dx
  5. Tx
A
  1. Predisposing Condition:
    - - <1 y.o.a
    - - unimmunized patients
  2. Pathophysiological insult/ Common Cause:

Acquired through droplet exposure, attach to respiratory cilia and inhibit the defense mechanisms, enables microaspiration which causes coughing

  1. Clinical Manifestation: 3 stages:
    - - CATARRHAL stage 1-2 weeks: mild cough and coryza

– PAROXYMAL stage 2-8 weeks: Cough increases with paroxysms causing gagging and cyanosis, struggle for breath, episodes occur spontaneously, worse at night, Coughing is followed by a whoop sound which is a forced inspiratory effort

– CONVALASCENT Stage 2 weeks: symptoms begin to resolve

On labs: Leukocytosis/lymphocytosis
Can cause apnea in infants

  1. Dx: culture or PCR
  2. Tx: Azithromycin
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25
Tuberculosis 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: - - Previous contact with someone who has TB - - Foreign born or has parent who is foreign born 2. Pathophysiological insult/ Common Cause: - - respiratory droplets carry tubercle bacilli to the alveolar space - - proliferate in alveolar macrophages and form a nodular granulomatous structure called a tubercle - - As bacilli proliferate the tubercle enlarges into lung parenchyma and lympnodes and form a GHON complex - - Can cause generalized lymphadenopathy when this occurs --> 90% of people develop an immune response at this point to halt spread - - Reactivation can occur when the body is immune suppressed. Typically seen in lung apices 3. Clinical Manifestation: Pulmonary TB: cough greater than 3 weeks, fever greater than 2 weeks, weight loss, possibly failure to thrive. Symptoms may be harder to pick up in very young patients and can be nonspecific. 4. Dx: (a) . TST (skin test) must be > 6mos of age, can be + in both latent and active infections, if negative, test does NOT rule out TB (b. ) Interferon Gamma Release Assay: (Qauntiferon Gold Study) more specific in latent TB, blood sample (c. ) AFB culture: gastric lavage in the morning before standing (d. ) Chest X-ray can pick up TB in adolescents: cavitary lesion in the lung apices with lymphadenopathy noted 5. Tx: Mulitdrug therapy using - - Isoniazid, Rifampin, Pyrazinamide, Ethambutol, see uptodate
26
Gastroenteritis 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: - -Fall/winter predominance - - Rota virus- 6mos to 2 years of age - - Norovirus- all ages - - Outbreaks in daycare or schools - - Contact with symptomatic/asymptomatic carriers 2. Pathophysiological insult/ Common Causes: - - Pathogen infiltrates the intestine and destroys the enterocytes - - Increased fluid and salt loss in stool - - Decreased digestion of carbohydrates 3. Clinical Manifestations: - - Vomiting for 1-2 days, diarrhea for 5-7 days (>3-4 loose stools in 24 hrs) - - Fever, Cramping abdominal pain, Hypovolemic dehydration, Hyper/hyponatremia, hypokalemia, metabolic acidosis 4. Dx: Exam and history 5. Tx: Supportive
27
Celiac Disease 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: - - primarily caucasions - - trisomy 21 - - Type 1 diabetes - - IgA deficiency - - Autoimmune thyroiditis - - Turner Syndrome - - Williams Syndrome - - 1st and 2nd degree relatives with Celiac Disease 2. Pathophysiological insult/ Common Causes: Not well understood, Immune disorder, gluten triggers an immune reaction in genetically predisposed people. IgA auto ab for endomysium and endomysium auto antigen transglutaminase *The endomysium contains a form of transglutaminase called "tissue transglutaminase" "tTG" ----> antibodies that bind to this form of transglutaminase are called endomysial autoantibodies (EmA). 3. Clinical Manifestations: steatorrhea, weight loss, small intestinal villous atrophy, FTT (failure to thrive), malabsorption, diarrhea, abdominal distention and pain 4. Dx: tTG-IgA antibody 5. Tx: Gluten free diet
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Clostridium Difficile 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: Previous antibiotic exposure, especially - - penicillins - - cephalosporins - - clindamycin - - flouroquinolones intestinal dysmotility 2. Pathophysiological insult/ Common Causes: - - Colonic microflora are altered, cdiff is ingested and over growth occurs - - c diff toxins A and B are released, intestinal epithelium is injured - - neonates and infants can be carriers 3. Clinical Manifestations: DIARRHEA-blood in stool is rare, lower abdominal pain 4. Dx: Test stool for toxin 5. Tx: Flagyl
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Toddlers Diarrhea 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: - - Infancy or preschool years - - increased JUICE consumption or other drinks/food with high osmotic load 2. Pathophysiological insult/ Common Causes: Incomplete absorption of water from the intestinal lumen due to either reduced rate of water reabsorption or osmotic retention of water in lumen 3. Clinical Manifestations: Painless passage of 3 or more large stools per day, loose 4. Dx: History 5. Tx: Refrain from juices and other drinks/food with high sugar/osmotic load
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Drugs Reaction/ Serum Sickness (category is fever & rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: Exposure to cephalosporins, penicillins, bactrim, anti-epileptics 2. Pathophysiological insult/ Common Causes: - - Serum sickness is a type 3 immune complex mediated hypersensitivity reaction - - the antigen of the drug binds with IgG and deposits in certain areas, compliment system gets activated 3. Clinical Manifestations: - - symptoms occur 1-2 weeks after exposure, may have fever, arthritis and urticaria like rash - - no mucous membrane involvement 4. Dx: H&P 5. Tx: Remove offending agent, supportive care
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Kawasaki Disease (category is fever & rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: < 5yo 2. Pathophysiological insult/ Common Causes: Medium vessel vasculitis 3. Clinical Manifestations: - - 5 days of fever at minimum - - 5 criteria: (a) Eyes: bilateral non exudate with conjunctivitis (b) Mouth: mucositis-strawberry tongue, cracked lips (c) Neck: cervical lymphadenopathy- typically one node over lying the sternocleidomastoid (d) Extremities: swelling (e) Skin: rash-sometimes starting in the perineal area and desquamating and then progressing to morbilliform or target lesions on the trunk with erythematous palms and soles -- Most common complication: Coronary aneurysms -- Other findings, thrombocytosis, sterile pyuria 4. Dx: Exam 5. Tx: IVIG and ASA (aspirin)
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Meningococcemia (category is fever & rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: Bimodal: < 5yo (pk is 2yo) and 16-21 yo Compliment deficient 2. Pathophysiological insult/ Common Causes: Aerosolized, goes to the nasopharyngeal mucosa and attaches on the epithelium, enters blood stream 3. Clinical Manifestations: symptoms of meningitis, fever, nausea, vomiting, headache, unstable vitals, DIC, purpuric rash is a late finding 4. Dx: Blood culture and exam 5. Tx: Ceftriaxone
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Lyme Disease (category is fever & rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: - - 5-10 yoa - - Tick endemic areas - - Summer time 2. Pathophysiological insult/ Common Causes: - - Deer Tick, Lone Star Tick, American Dog Tick feed on rodent who carries the spirochete Borrelia Burgdorferi and becomes a vector - - The tick then bites a human and spreads the spirochete. 3. Clinical Manifestations: Three phases: (a) Early: - - Erythema Migrans at the site of the bite, bulls eye in appearance or completely confluent - - Can have fever, fatigue, myalgia, Headache, Neck pain, Arthralgia (b) Early Disseminated: - - May have multiple erythema migrans - - Cranial nerve palsies- esp. the facial nerve (CN7) - - Carditis - - Heart Block - - Meningitis (c) Late Disease: - - Arthritis in large joints 4. Dx: Elisa and Western blot for antibodies to Borrelia Burgdorferi 5. Tx: Doxycycline
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Rickettsial Disease (category is fever & rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: can occur anywhere but is endemic in the SOUTH EASTERN and SOUTH CENTRAL states in the spring and summer months 2. Pathophysiological insult/ Common Causes: - - gram negative intracellular bacterium that affects the vascular endothelium, causing injury and leaking - - this leads to intravascular volume depletion and an increased in ADH causing hyponatremia - - rarely the clotting cascade can be activated causing DIC 3. Clinical Manifestations: - - fever - - headache - - rash- macular becoming petechial, spreads from ankles/wrists to trunk - - increased LFTS - - low sodium 4. Dx: Serology 5. Tx: Doxycycline
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Toxic Shock Syndrome (category is fever & rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: Menstruating females Patients with skin infections 2. Pathophysiological insult/ Common Causes: - - Staph releases : toxic shock syndrome toxin 1 and enterotoxin B - - TSST1 activates a large number of T cells and this causes a massive cytokine release 3. Clinical Manifestations: - - erythroderma, palms and soles are affected - - low blood pressure - - myalgia - - weakness - - diarrhea - - low sodium, calcium, albumin, phosphorous - - encephalopathy 4. Dx: H&P, blood and urine culture, look for retained tampon 5. Tx: Vancomycin
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Brain Tumor (category is headache) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: Exposure to ionizing radiation, genetic predispostion Neurofibromatosis, Tuberous sclerosis, von Hippel-Lindau syndrome 2. Pathophysiological insult/ Common Causes: This skull is a fixed compartment, ICP is a function of the volume and compliance of each component of the compartment. When something foreign is introduced the components of the system are displaced or ICP increases or both may occur. 3. Clinical Manifestations: Infants: -- irritability, vomiting, MACROcephaly, may be lethargic Older children: - - headache- typically in morning and relieved by vomiting, may also occur at night - - abnormal gait, poor coordination- handwriting, speech, clumsiness - - nausea, vomiting, papillaedema, seizures - - cranial neuropathies - - vision changes 4. Dx: Head Imaging, CT if emergent, then MRI 5. Tx: Various modalities, including resection
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Meningitis (category is headache) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: Patient is LESS than 1 month: - - premature rupture of membranes (PROM) - - low birth weight, born at <37 weeks - - septic delivery/maternal infection - - fetal hypoxia - - maternal UTI/infection Patient is GREATER than 1 month: - - recent exposure to someone with meningitis - - recent respiratory or ear infections - - travel to a N Men. endemic area - - csf leak, cochlear implant, VP shunt 3. Common Causes: < 1mos of age: - - group b strep and ecoli - - Patients in the 1st week of life may contract from vaginal flora - - Patients from 1-4 weeks of life may acquire disease from community vs mother 1mos-3mos of age: -- group b strep, strep pneumo and neiseria 3mos to 3 years: -- group b strep, strep pneumo, neiseria men., gram negatives 3yrs to 10 yrs: -- strep pneumo and neisseria 10-19 yrs: -- Neiseria Men. General: -- bacteria colonizes host mucosal epithelium and enters blood stream, crosses the blood brain barrier and multiplies in the csf ``` 3. Clinical Manifestations: <1 month of age and infants: -- temp instability, irritability or lethargy, -- decrease in tone, seizures, -- decreased feeding -- respiratory distress ``` Older children: - - Nuchal rigidity, kernig/brudzinski, - - photophobia, fever, nausea and vomiting - - altered mental status, headache and seizures - - Petechia and purpura rash for N meningitis 4. Dx: LP: CSF findings show increased WBC and protein with decreased glucose, CSF culture is positive 5. Tx: <1-2mos of age = cefotaxime/ceftriaxone and ampicillin >2mos = Ceftriaxone and vancomycin
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Tension Headache (category is headache) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: none 2. Pathophysiological insult/ Common Causes: Unknown, possibly heightened sensitivity of pain pathways in the central and peripheral nervous system. Nitric Oxide may be a molecular trigger for pain 3. Clinical Manifestations: - - BILATERAL pressing tightness that occurs anywhere on the cranium or suboccipital region - - non throbbing, duration of 30 minutes to several days - - mild-moderate in intensity, photophobia and phonophobia are rare, vomiting usually dose not occur 4. : H&P 5, Tx: Acetaminophen and Ibuprofen
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Migraines (category is headache) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: can occur at all ages but typically in boys as early as 7 and girls 10 2. Pathophysiological insult/ Common Causes: -- Thought to be both genetic and environmental factors which cause a primary neuronal dysfunction. -- Aura may be caused by a wave of neuronal and glial depolarization across the cerebral cortex. This is called Cortical Spreading Depression. This causes the trigeminal afferents to be activated, causing inflammation in the pain sensitive meninges which causes the migraine headache -- Serotonin plays a role by affecting the cerebral vasculature, central pain control pathways, and the cerebral cortical projections of the brainstem serotonergic nuclei. -- A decline in serotonin function has been noted in adults with acute migraine attacks -- CRGP (calcitonin gene related peptide) is expressed in the trigeminal nerves and mediates vasodilation of the cerebral and dural vessels, sumatriptans (serotonin agonist) normalize the CRGP levels 3. Clinical Manifestations: Occurs in stages: (a.) Migraine prodrome Phase: -- affective/vegetative symptoms that occur before the onset of headache such as neck stiffness, social withdrawal, euphoria, irritability, food cravings, increased yawning, constipation (b. ) Migraine aura Phase: - - usually visual, consists of spots or colored lights, scotomata, complex visual images - - A sensory aura may consist of tingling in a limb or on the side of the face, numbness occurs as it migrates - - May have language aura with dysphagia. - - All auras usually occur 30 minutes before the headache. (c. ) Migraine Headache Phase: - - throbbing, pulsatile, location is usually frontal in younger children and bitemporal is seen in older children - - May also present as generalized in any age, unilateral - - Nausea, vomiting, photophobia, phonophobia - - Cranial autonomic symptoms in 70% of patients- sense of aural fullness, forehead/facial sweating and or flushing, lacrimation, conjunctival injection, ptosis and or miosis, nasal congestion and or rhinorrhea, periorbital edema (d. ) Migraine Postrdrome Phase: - - feel drained or exhausted 4. Dx: H&P 5. Tx: Tylenol and Motrin if not working advance to Triptans (serotonin agonist), anti nausea/vomiting (compazine), some use ergotomines....see UpToDate
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Concussion (category is headache) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: participants in collision sports 2. Pathophysiological insult/ Common Causes: Results from rapid rotational acceleration of the brain causing neuronal depolarization, lactic acid accumulation and decreased cerebral blood flow with a decrease in glucose available for the brain leading to cognitive issues and concussion symptoms 3. Clinical Manifestations: headache, confusion, disorientation, difficulty with memory, blank stare, inattentive, slow or incoherent speech, dizzy, ataxic, vomiting, emotionally labile 4. Dx: H&P 5. Tx: Supportive care, Return to activity depends on symptoms and severity of concussion
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Hydrocephalus (category is headache) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
``` 1. Predisposing Conditions: Risks for infantile hydrocephalus --> -- Birth weight < 1500 grams -- Prematurity < 30 wks -- Maternal diabetes -- anatomic malformations, brain bleed, -- brain infection-meningitis -- neural tube defects -- tumor, trauma ``` 2. Pathophysiological insult/ Common Causes: Two possible ---> a) OBSTRUCTION of CSF (most common) or inadequate absorption or b) OVERPRODUCTION causing increased CSF volume and increased ventricular pressure and resulting in dilation. 3. Clinical Manifestations: - - Headache, nausea, vomiting, altered mental status and mood, personality changes, fussy, lethargic, poor feeding - - symptoms timing depends on if this is a chronic or acute process - - Infants without fused sutures may tolerate increased INCP longer and present later macrocephaly - - CUSHING TRIAD: a) hypertension b) bradycardia c) abnormal respirations (Cheyne-Stokes breathing) - - Papilledema - - Cranial neuropathies: ex) diplopia, impairment of upward gaze( setting sun sign) 4. Dx: CT/MRI 5. Tx: VP (ventriculoperitoneal) Shunt
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Developmental Dysplasia of the Hip (category is limb and extremity pain) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: Female, breech, oligohydraminios, 1st born, hx of swaddling, family hx 2. Pathophysiological insult/ Common Causes: - - In the womb the femoral head grows faster than the acetabulum and if the fetus is restricted in movement then the femoral head is not centered with in the acetabulum, leading to dislocation due to poor acetabulum formation - - After birth, ligaments are laxed, if swaddled in the extended position then the femoral head may not be centered in the acetabulum and dislocation may occur due to poor acetabulum formation. 3. Clinical Manifestations: - - + Ortolani and/or Barlow test - - asymmetric leg creases, shortening of the femur - - late finding can be trendelenburg gait 4. Dx: Exam and ULTRASOUND 5. Tx: Surgery
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Acute Rheumatic Fever (category is limb and extremity pain) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: Group A Strep, untreated 2. Pathophysiological insult/ Common Causes: - - 2-3 weeks after a Group A Strep infection - - confused immune system --> B and T cells react against the body 3. Clinical Manifestations: Jones Criteria = - - ARTHRITIS - large joints migratory, more than one - - CARDITIS - Pan carditis, valvulitis, mitral valve stenosis, aortic regurgitation - - Sydenham's CHOREA - - Sub Q NODULES -firm and painless, on boney surfaces, tendons - - ERYTHEMA MARGINATUM - starts on trunk and moves out - - Arthralgia, fever, increased ESR and CRP 4. Dx: Exam findings, Jones Criteria, Labs = elevated ASO titer 5. Tx: PCN and NSAIDS
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Juvenile Rheumatoid Arthritis/ Idiopathic RA (category is limb and extremity pain) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: SYSTEMIC: none POLYARTICULAR: biphasic onset at 2-5 yoa and 10-14 yoa OLIGOARTICULAR: age of onset peaks at 2-3 yoa 2. Pathophysiological insult/ Common Causes: pathology is unclear, felt to be a combination of both genetic and environmental factors 3. Clinical Manifestations: SYSTEMIC ----> -- quotidian *FEVER ( spike every 24 hrs) for at least 2 weeks -- salmon pink rash increased by heat and touch (koebner phenomenon) -- arthritis for at least 6 weeks, wrist, knees and ankles -- may have increased ESR/CRP, WBC and platelets and decrease Hgb POLYARTICULAR: ----> - - >4 joints, symmetric, knees, wrists and ankles - - warm, tender, swollen and NOT red NO FEVER or rash - - increased ESR, IgG, - - decreased Hgb and +ANA OLIGO: ----> -- <5 joints, knees and ankles, warm, tender, swollen and not red NO FEVER or rash Dx: Exam and Labs Tx: Immune suppressive medications
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Legg-Calve Perthes Disease (category is limb and extremity pain) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: Age range is 3-12, peak is 5-7 Males more than females 2. Pathophysiological insult/ Common Causes: Avascular necrosis of the hip 3. Clinical Manifestations: - - Acute and insidious hip or limb pain, pain increases with activity - - xray reveals the femoral head is gone or blunted 4. Dx: Exam and Imaging 5. Tx: Non-weight bearing and Splinting to keep femoral head within the acetabulum
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Osgood Schlatter Disease (category is limb and extremity pain) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: 9-14 yo, undergoing rapid growth, usually athletes, can be bilateral 2. Pathophysiological insult/ Common Causes: - - repetitive strain and chronic avulsion of the secondary ossification center of the tibial tubercle - - proximal patellar tendon insertion separates from tibial tubercle = elevation and callous formation 3. Clinical Manifestations: - - Pain in anterior portion of the knee; increases over time - - Exacerbated by trauma, kneeling, squatting, running, jumping, climbing upstairs or walking up hill - - Relieved by rest 4, Dx: Exam 5. Tx: NSAIDS, Ice, PT to stretch and strengthen the quadriceps and hamstrings
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Osteomylitis (category is limb and extremity pain) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: - - over 50% occur in children less then 5 - - risk factors = sickle cell disease, immune deficiency, sepsis, trauma with bacteremia, central lines 2. Pathophysiological insult/ Common Causes: 3 modes----> (1) BLOODSTREAM = carry an infection from another part of the body to the bones (2) DIRECT invasion = via open fractures, surgery, or objects that pierce the bone (3) INFECTIONS in NEARBY structures, such as natural or artificial joints or soft tissues -- Etiology: staph aureus, sickle cell patients may have salmonella 3. Clinical Manifestations: Non-specific, starting with malaise and fever. Warmth and swelling, point tenderness, decreased function and weight bearing 4. Dx: MRI 5. Tx: Clindamycin
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Reactive Arthritis (category is limb and extremity pain) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: - - 3-8 yrs, peak age is 5-6 - - 30-50% have a hx of URI ``` 2. Pathophysiological insult/ Common Causes: Chlamydia infection (mc); UTIs ``` 3. Clinical Manifestations: - - Usually AFEBRILE or LOW grade, pain, decreased motion of the joint, well appearing - - may be in the frog leg position if hip is involved- leg is flexed and externally rotated - - labs are not impressive - - no redness or swelling of joint 4. Dx: Not always done, would do if not improving on NSAIDs--> MRI, Joint Aspiration Normal/ sightly elevated: CBC, CRP, ESR 5. Tx: Scheduled NSAIDS
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Septic Arthritis (category is limb and extremity pain) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: Children < 3 are most at risk 2. Pathophysiological insult/ Common Causes: - - Bacteria enters blood stream, high flow and lack of basement membrane in synovium enables infection. - - Bacteria deposits in synovium, causing inflammation and enters synovial fluid - - Host cells release cytokines- causing release of proteolytic enzymes and increasing WBC recruitment. - - Synovium and cartilage are damaged - - Staph is the most common, can be strep or kingella (indolent course) 3. Clinical Manifestations: - - Typically SINGLE joint, knee, hip or ankle - - Acute onset of fever, joint pain and swelling with decreased range of motion - - Erythematous, refusing to use limb or bear weight 4. Dx: - - Elevated CRP/ESR and Abnormal CBC - - May get MRI or US showing inflammation and effusion - - Joint aspiration shows >50,000 WBC with predominance of polymorphonuclear leukocytes 5. Tx: Clindamycin or Vanc if unstable
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Slipped Capital Femoral Epiphysis (SCFE) (category is limb and extremity pain) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: Obese Early adolescent, 12-13 2. Pathophysiological insult/ Common Causes: Femoral head slips posteriorly from the femoral epiphysis 3. Clinical Manifestations: Limp, limited internal rotation, hip pain and limping, pain may be referred to the thigh, may be indolent 4. Dx: X-ray "ice cream slipping off cone" 5. Tx: surgery to stabilize the growth plate that slipped; prior to surgery = rest; use of crutches to avoid bearing weight
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Cervical Lymphadenitis (category is lymphadenopathy) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: May have a hx of recent URI 2. Pathophysiological insult/ Common Causes: - - Unknown but hypothesized that bacteria penetrate the mucosa or skin of the head and neck and infiltrate the surrounding tissues and go into the lymph vessels to lymphnodes -- etiology is typically staph aureus or Group A Strep 3. Clinical Manifestations: usually UNILATERAL overlying erythema, warmth and tenderness, may be indurated and/or fluctuant limited neck rotation 4. Dx: CT scan or Ultrasound 5. Tx: Clindamycin
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Cat Scratch Disease (category is lymphadenopathy) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: cat scratch or bite 2. Pathophysiological insult/ Common Causes: - - Bartonella Henselae, cat bite or scratch allows organism to enter the body - - can be either localized or systemic infection 3. Clinical Manifestations: - - 90% have a localized skin and lymph node involvement close to the bite - - 3-10 days after inoculation, goes through vesicular, erythematous and papular phases - - enlarged nodes appear proximal to the inoculation site 2 weeks after bite, tender, red, sometimes draining - - Most common sites are axillary, epitrochlear, cervial, supraclavicular, and submandibular nodes - - can have prolonged fever, hepatomegaly and splenomegaly 4. Dx: History and culture of blood or lymph node 5. Tx: Azithromycin or Doxycycline
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HIV (category is lymphadenopathy) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
``` 1. Predisposing Conditions: Patient born to mother with HIV Sexual encounters with an HIV carrier Injectable drug use Blood to Blood contact with carrier" ``` 2. Pathophysiological insult/ Common Causes: 95% of infected children acquire HIV through VERTICAL TRANSMISSION = during pregnancy, delivery or breast feeding 3. Clinical Manifestations: - - usually non specific = lymphadenopthy and hepato-splenomegaly (HSM) - - Infants may have FTT, thrush, developmental delay - - most common symptoms in children with AIDS are.... a) PCP pneumonia b) recurrent bacterial infections c) waiting syndrome (FTT) d) esophageal candidiasis e) HIV encephalopathy f) CMV pneumonia g) colitis h) encephalitis i) retinitis 4. Dx: Viral assays must be used for dx in children < 18mos (HIV RNA and DNA tests) Testing is done at 2 weeks, 2 mos and 4 mos If + repeat test on another specimen for confirmation 5. Tx: Anti-retroviral therapy
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Non Tuberculous Mycobacterial Adenitis (category is lymphadenopathy) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: Typically between 1-5 yrs of age 2. Pathophysiological insult/ Common Causes: Mycoplasma is the most common etiology 3. Clinical Manifestations: - - UNILATERAL, nontender node - - slowly emerges over several weeks - - skin goes from pink to violaceous and thin to become parchment like and then drain through a sinus tract - - may be fluctuant - - Fails to improve or worsens with antibiotics - - submandibular nodes are involved, sometimes other nodes such as mediastinal - - +/-fever 4. Dx: Biopsy and culture, must remove complete node 5. Tx: Azithromycin
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Leukemia (category is Organomegaly: splenomegaly/hydronephrosis) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: peak incidence is 2-5 years of age Down Syndrome 2. Pathophysiological insult/ Common Causes: multifactorial 3. Clinical Manifestations: - - Nonspecific= Hepatosplenomegaly, Mediastinal mass, fever, bleeding, bone pain-occurs in long bones, may have joint pain - - lymphadenopathy-present in 50% present, usually greater than 10mm, nontender, rubbery, firm, matted - - Most children with ALL have anemia and/or thrombocytopenia, with normal or slightly increased WBC counts and lymphoblasts on peripheral smear 4. Dx: Bone Marrow Bx and Peripheral Smear 5. Tx: Various Chemotherapy regimens, stem cell transplants etc
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Hemolytic Anemia (category is Organomegaly: splenomegaly/hydronephrosis) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: - - Spherocytosis/G6PD: Physiologic predisposition -- Autoimmune hemolytic disease: may have a preceding viral illness or another autoimmune process or systemic illness in the background causing the anemia. 2. Pathophysiological insult/ Common Causes: INTRINSIC: inherited abnormalities of the hemoglobin, erythrocyte membrane, intracellular red cell enzymes Ex: a) Spherocytosis: Deficiency of erythrocyte membrane protein spectrin; spleen destroys RBC sickle cell disease (see scd) b) Thalassemia c) Glucose 6 phosphate dehydrogenase deficiency: Glucose 6 phosphate is dehydrogenase protects the RBC from oxidative stress, when its deficient oxidant metabolites of numerous drugs case denaturation and precipitation of hemoglobin causing hemolysis EXTRINSIC: acquired and result from forces or agents that immunologically, chemically, or physically damage the erythrocyte Ex: a) Autoimmune Hemolytic Anemias: antibodies directed towards specific membrane antigens causing hemolysis Primary: underlying disease is absent, Secondary: underlying disease is present such as lupus 3. Clinical Manifestations: INTRINSIC: a) Spherocytosis: anemia, if a neonate- hyperbili, older patients may have splenomegaly or chronic anemia b) G-6-PD: anemia, hemoglobinuria EXTRINSIC: a) Autoimmune Hemolytic Anemias: pallor, jaundice, splenomegaly, hemoglobinuria, splenomegaly 4. Dx: Peripheral Smear, Coombs Test, other testing depending on disease process 5. Tx: Dependent on disease
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Sickle Cell Anemia (category is Organomegaly: splenomegaly/hydronephrosis) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: - - Hgb SS - - Sickle Cell crisis may be precipitated by illness, hypoxia, fever, dehydration 2. Pathophysiological insult/ Common Causes: Substitution of VALINE --> GLUTAMIC ACID in the beta hemoglobin chain produces a hgb tetramer that is poorly soluble when deoxygenated, becomes elongated and forms a sickle shape 3. Clinical Manifestations: - - Chronically anemic, have pain episodes due to vasoocclusive episodes -- Children <2: DACTYLITIS is the most common presentation-pain in hands and feet -- Children >2: may have acute pain syndromes and splenic sequestration -- Vasoocclusion can occur in any organ system 4. Dx: Hgb Electrophoresis, Peripheral Smear 5. Tx: Supportive Care, Pneumococcal vaccine while spleen is present, Penicillin prophylaxis
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Hydronephrosis (category is Organomegaly: splenomegaly/hydronephrosis) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: More common in boys vs girls Bilateral in 20-40% of cases Posterior urethral valves are the most common etiology of urinary tract obstruction in males 2. Pathophysiological insult/ Common Causes: - - URETROPELVIC JXN obstruction is the most common cause followed by VESICOURETERAL REFLUX - - Other causes may be POSTERIOR URETHRAL VALVES 3. Clinical Manifestations: UPJ obstruction: antenatal hydronephrosis, abdominal mass, UTI, hematuria, FTT, flank or abdominal pain Posterior Urethral Valves: dilated bladder, bilateral hydropnephrosis, thick bladder wall, if severe enough may have oligohydramnios and respiratory distress, less severe cases may present with a UTI, poor urinary stream, straining with urination VUR: UTI, Abdominal mass 4. Dx: - - Imaging through VCUG (voiding cystourethrogram) for posterior urethral valves and VUR -- CT without contrast to look for stone/UPJx obstruction, US Tx: Surgical
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Otitis Media (category is otalgia) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: - - occurs at all ages but most prevalent in infancy - - Daycare - - lack of breast feeding - - tobacco smoke exposure - - pacifier use 2. Pathophysiological insult/ Common Causes: viral URI causes inflammation and edema of the mucosa of the nose, nasopharyx and eustachian tube, and the tube obstructs--> Leading to negative ear pressure and accumulation of secretions that can't drain Viruses and bacteria enter the middle ear through the upper respiratory tract and grow, leading to pus etc. etiology: may be viruses, bacteria or both most common bacteria are strep pneumo, moraxella and non typeable H Flu 3. Clinical Manifestations: fever irritability ear pain Hearing Loss **Bulging tympanic membrane, red tympanic membrane **Middle ear effusion: tympanic membrane opacity, DEC MOBILITY, air-fluid level or otorrhea 4. Dx: Exam 5. Tx: Amoxicillin
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Otitis Externa (category is otalgia) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: Summer time Swimming 2. Pathophysiological insult/ Common Causes: - - Break down of skin and cerumen barrier - - pH increases allowing for a warm alkaline moist environment, PSEUDOMONAS is the main cause 3. Clinical Manifestations: - - Pain with manipulation of the auricle or pressure exerted on the tragus - - Ear canal is edematous and erythematous, drainage or debris may be noted - - Tympanic membrane IS MOBILE (opposite of otitis media) with insufflation 4. Dx: Exam 5. Tx: Cipro
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Otitis Media with Effusion (category is otalgia) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: - - History of otitis media - - more common in winter, chances increase if in daycare or bottle fed, smoke exposure - - may have increased adenoids 2. Pathophysiological insult/ Common Causes: CHRONIC INFLAMMATION in response to residual bacterial components from acute Otitis media 3. Clinical Manifestations: hearing loss, no signs of infection, TM is neutral or retracted, not bulging or red, DEC TM mobility, may see Amber fluid or air fluid level 4. Dx: Exam 5. Tx: Observation
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Mastoiditis (category is otalgia) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: Acute Otitis Media High incidence in children < 2 yoa 2. Pathophysiological insult/ Common Causes: - - Suppurative infection of the mastoid air cells, middle ear and mastoid air cells are continuous. - - Patient gets acute Otitis media, middle ear mucosa and mastoid mucosa get inflamed - - if inflammation does not improve puss develops and mastoiditis occurs **Main etiology is STREP PNEUMO STREP PYOGENES STAPH AURESUS 3. Clinical Manifestations: Posterior auricular tenderness, protrusion of the auricle, ear pain, fever, abnormal tympanic membrane 4. Dx: CT scan and exam 5. Tx: Surgical and abx, usually clindamycin
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Immune Thrombocytopenia (category is rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: Peak ages 2-5 yrs, possible prior history of infection 2. Pathophysiological insult/ Common Causes: Auto antibodies are directed against platelet antigens and are cleared through the spleen 3. Clinical Manifestations: - - sudden bruising /bleeding(oral & nasal usually) or petechial rash - - usually no other systemic symptoms, - - thrombocytopenia on CBC 4. Dx: Exam and CBC findings 5. Tx: Supportive If needed IVIG or steroids or transfusion
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Atopic Dermatitis (category is rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: usually presents <5yoa positive family hx of eczema, allergies or asthma 2. Pathophysiological insult/ Common Causes: Epidermis keeps environmental irritants, allergens and microbes from entering the body and prevents excess water loss. Patients with eczema are believed to have a genetically impaired skin barrier that allows for increased water loss. One of the main mutations is in the FILAGRIN protein, which is a key component for the barrier function of the skin. In addition, they also have immune dysregulation. 3. Clinical Manifestations: 0-2 years of age: pruritic red and scaly lesions on the EXTENSOR surfaces and cheeks or scalp 2-16 years of age: lichenified plaques on the FLEXURAL surfaces, especially the antecubital and popliteal areas, VOLAR aspects of the wrists, ankles and neck 4. Dx: H&P ``` 5. Tx: Steroid creams Moisturizing Hypoallergenic products Antipruritics ```
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Drug Rxn/ Allergy (category is rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: Type 1 reaction medications: penicillins, cephalosporins 2. Pathophysiological insult/ Common Causes: Type 1: IMMEDIATE in onset, mediated by IgE and MAST cells and or BASOPHILS *most common, previous exposure required Type 2: DELAYED onset and caused by ANTIBODY-MEDIATED cell destruction Type 3: DELAYED onset, and caused by IgG, drug immune COMPLEX DEPOSITION and COMPLEMENT activation Type 4: DELAYED onset and T-CELL-MEDIATED. *most common ``` 3. Clinical Manifestations: Type 1: urticarial rash, pruritus, flushing, angioedema of the face, extremities or laryngeal tissues, wheezing, GI symptoms and/or hypotension, immediate Anaphylaxis Examples: penicillins, cephalosporins ``` Type 2: drug binds to a cell and acts as an antigen and is cleared, clinical signs are hemolytic anemia, thrombocytopenia, neutropenia, 5-8 days after exposure Examples: proplythiouracil, antimalarial drugs, flecainide Type 3: serum sickness, drug fever, vasculitis, 1 or more weeks Type 4: prominent skin findings contact dermatitis Stevens Johnson Syndrome and Toxic epidermal necrolysis (blistering of skin and mucosa) penicillins, cephalosporins, anti epileptics, viruses 4. Dx: H&P 5. Tx: Withdraw offending agent; Treat symptoms
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Contact Dermatitis (category is rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: - - Diaper dermatitis= diarrhea or chronic stooling - - Recent use of abx - - Contact dermatitis= warm months when poison ivy is present 2. Pathophysiological insult/ Common Causes: IRRITANT contact dermatitis: -- exposure to substances that cause physical, mechanical or chemical irritation to the skin DIAPER-dermatitis: - - moisture, friction, increased pH and high enzymatic activity cause disruption of the skin barrier - - bacteria produces urease which reacts with urine to increase the pH level , activating fecal enzymes (protease and lipase) which cause an inflammatory skin reaction - - Skin also becomes more susceptible to colonization of staph aureus and strep pyogenes as well as candida ALLERGIC contact dermatitis: - - Type 4 reaction occurring at the skin - - sensitization phase: initial exposure to the antigen, antigen taken up by langerhans cells and then taken to regional lympnodes, presented to T lymphocytes which become specific for this antigen and undergo cloning - - Upon reexposure they are activated, release inflammatory mediators, produce a localized dermatitis 3. Clinical Manifestations: IRRITANT contact dermatitis & DIAPER dermatitis: range of findings depending on severity scattered erythematous papules with mild erythema to extensive erythema with maceration or superficial erosions to extensive erythema with glossy appearance, painful erosions, papules and nodules ALLERGIC contact dermatitis: poison ivy erythema, edema, vesicles or bulla, often rupture and leave a crust 4. Dx: Exam 5. Tx: Supportive and possibly steroids
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Erythema Toxicum (category is rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: more common in FULL-TERM infants 2. Pathophysiological insult/ Common Causes: immaturity of the PILOSEBACEOUS follicles may be a factor 3. Clinical Manifestations: multiple erythematous macules and papules that rapidly progress to pustules on an erythematous base, present over trunk and proximal extremities, spare the palms and soles Appear within 24-48 hrs of birth, resolves within 5-7 days but can wax and wane 4. Dx: Exam 5. Tx: no treatment, goes away
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Cellulitis (category is rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: insect bites eczema skin injury 2. Pathophysiological insult/ Common Causes: - - most common etiologies: beta hemolytic STREP, STAPH AUREUS -- Bacteria enter skin through breach in skin barrier, causing infection/inflammation of the deeper dermis and sub cutaneous fat 3. Clinical Manifestations: lower extremities are the most common, skin erythema , edema and warmth may see lymphangitis or abscess 4. Dx: Exam 5. Tx: Clindamycin
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Molluscum Contagiosum (category is rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: contact with someone who has it 2. Pathophysiological insult/ Common Causes: from the POX VIRUS FAMILY, spread by direct skin to skin contact, one can also autoinnoculate 3. Clinical manifestations - - firm, DOME-shaped papules on the skin, 2-5mm in diameter with a shiny surface and CENTRAL INDENTATION/UMBILICATION - - can cause pruritus - - typically occur on the on trunk , axilla, ante-cubital and popliteal fossa and crural folds - - does NOT occur on palms or soles 4. Dx: Exam 5. Tx: Improves with time, supportive care
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Impetigo (category is rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: 2-5 years of age Carriers of STAPH AUREUS or GROUP A STREP (GAS) 2. Pathophysiological insult/ Common Causes: minor skin trauma allows bacteria inside, staph or strep 3. Clinicla manifestations: NON-BULLOUS --> Papules become vesicles and have surrounding erythema and then progress to pustules and break-honey colored CRUST, usually on FACE and EXTREMITIES BULLOUS --> vesicles enlarge forming flaccid bulla with yellow fluid, FEWER LESIONS then non-bullous and usually on the TRUNK 4. Dx: Exam 5. Tx: Anti-staph and strep coverage Keflex, Bactrim, Clinda, Topical anti staph coverage
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Warts (category is rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: Contact with someone with warts 2. Pathophysiological insult/ Common Causes: HPV spread by DIRECT SKIN CONTACT, incubates for 2-6 weeks 3. Clinical manifestations: common warts, plantar warts on feet, flat warts on forehead, if shaved of you see capillary dots 4. Dx: Exam 5. Tx: Will go away on own, multiple treatments out their, freezing off for example
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Lice (category is rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: More common in Caucasian than African American 2. Pathophysiological insult/ Common Causes: females lay eggs (nits) at the base of the hair shaft, hatch and nymphs mature and attach to hair, suck blood, spread by contact 3. Clinical manifestations: Pruritus and excoriations, see nits in hair 4. Dx: Exam 5. Tx: Permethrin
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Scabies (category is rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: Contact with someone who has it 2. Pathophysiological insult/ Common Causes: Sarcoptes Scabiei: transmitted from person to person contact, female burrows into the epidermis, lay eggs, larvae hatch and mature and start cycle again 3. Clinical manifestations: - - Small erythematous Papules - - Thin greyish/reddish burrow lines on on palms and soles, sides and webs of fingers, flexor wrists, extensor elbows axilla, genitalia, knee, buttocks, thighs, posterior aspects of feet, can have wheels, pustules and vesicles - - Itching is out of proportion to the lesions and worse at night 4. Dx: Microscopic evaluation of scrapings 5. Tx: Permethrin
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Seborrhic Dermatitis (category is rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: 3 weeks to 12mos of age 2. Pathophysiological insult/ Common Causes: Unknown 3. Clinical manifestations: - - Erythematous plaques, greasy yellowish - - plaques/scales on areas rich in sebaceous glands-scalp, ears, central face, intertriginous areas 4. Dx: H&P 5. Tx: Observe, keep moisturized, self limiting and improves Can use an antifungal such as ketoconazole and steroid creams depending on extent
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Urticaria (category is rash) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: Illness, medication exposure, previous allergies 2. Pathophysiological insult/ Common Causes: - - mast cells release histamine causing itching and vasodilation which causes swelling - - IgE type 1 reaction - - triggers = PCN, cephalosporins, bees, wasps, latex, milk, eggs, peanuts, transfusions, contrast 3. Clinical manifestations: Circumscribed and raised erythematous plaques with central pallor. May be round, oval or serpiginous, vary in size, worse where clothes compress skin 4. Dx: Exam 5. Tx: antihistamines, antipruritics, rarely steroids, avoidance of offending agents
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Conjunctivitis (category is Red or Wandering Eye) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: ALLERGIC conjunctvitis --> may have hx of atopy CONTACT with someone who has infectious conjunctivitis 2. Pathophysiological insult/ Common Causes: - - inflammation of the conjunctiva, which is the mucous membrane lining the eyelids, and surface of the globe to the limbus (junction of the sclera and cornea) -- Usually transparent but when inflamed it becomes pink, can be bacterial, viral, allergic or nonallergic -- ALLERGIC: airborne allergens that contact eye, IgE triggers mast cell release, -- BACTERIAL: staph, strep pneumo, H Flu, Moraxella, spread by direct contact with the patient and their secretions or with someone else who is contagious or and object that has been contaminated VIRAL: adenovirus typically spread in the same manner as bacterial 3. Clinical Manifestations: ALLERGIC : BILATERAL redness, itching, watery discharge, may have chemosis-conjunctival edema BACTERIAL: usually UNILATERAL but can be bilateral, secretions are usually thick and globular and yellow, white or green. Continues throughout the day VIAL: watery, mucoserous discharge, stingy, scant pus, sand papery feel, usually BILATERAL, 1 eye is affected first then 24-48hrs the other is affected 4. Dx: Exam 5. Tx: Depends on etiology allergic- supportive bacterial-abx eye drops viral-supportive
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Strabismus (category is Red or Wandering Eye) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: - - family history - - low birth weight - - lesions that cause vision deprivation - - cerebral injury 2. Pathophysiological insult/ Common Causes: - - can be congenital or acquired CONGENITAL : nerve palsies (CN 3 and 4), CNS insults; CN 6 for esotropia (abducens n. palsy) most common cause for ESOTROPIA: ACCOMODATIVE esotropia: occurs in children usually in 2nd year of life who are farsighted, to focus on a near object the ciliary muscle alters the lens, both eyes converge but this is controlled in unaffected children, versus in children with esotropia the convergence is not controlled and over convergence may occur IDIOPATHIC esotropia/CONGENITAL esotropia: occurs before 6 months, children have a low refractive error and are neurologically normal, may have a central anomaly of fusion most common cause of exotropia: INTERMITTEN exotropia: occurs at 2-3 years of age ACQUIRED: underlying pathology---> a) tumors, cataracts, trauma to head or orbit, cerebral hemorrhage b) diseases such as myasthenia gravis, botulism and Guillain-Barre syndrome c) Infections such as encephalitis, meningitis, orbital cellulitis 3. Clinical Manifestations: ESOTROPIA ---- inward deviation, most common EXOtropia ---- outward deviation may have abnormal head posture to accommodate; patient may complain of floating or drifting eye when tired, may be able to realign the eye with blinking or focusing on the issue AMBLYOPIA ---- reduced vision in affected eye, 50% of patients with strabismus Cover test: patient fixates on a target, cover eye, if strabismus is present in the uncovered eye that eye will refixate on the target 4. Dx: Exam 5. Tx: Surgery or eye patch depending on issue
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Corneal Abrasions (category is Red or Wandering Eye) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: Foreign body or trauma 2. Common Causes: -- Defect in the corneal surface of the epithelium -- Can be traumatic or spontaneous TRAUMATIC: abrasions due to finger nails, paws, foreign body under the lid, contacts SPONTANEOUS: abrasions occur without inciting event, may have hx of previous abrasion or underlying defect in cornea 3. Clinical Manifestations: photophobia, eye pain, foreign body sensation, watery eye, red eye 4. Dx: Flouroscein eye stain reveals defect 5. Tx: Depending on severity, no treatment or may require abx and steroid drops
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Epilepsy (category is seizures) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: - - Incidence is highest in the first few months of life - - can be genetic and/or related to metabolic disorders or past infections such as meningitis or Structural abnormalities or history of trauma 2. Pathphysiological insults/ Common Causes: FOCAL seizures: arise from a focal area in the brain that discharges. Symptoms correspond to that are of the brain. Can remain localized or spread globally to encompass the whole cortex GENERALIZED seizures: begin with abnormal discharges from both hemispheres of the brain at the same time 3. Clinical Manifestations: FOCAL Seizures (Partial) = can be conscious (simple/partial) or impaired consciousness (complex) -- can be subdivided further by : a) MOTOR sz: focal motor activity or anatomic spread or march of activity(Jacksonian March), or turning of eyes, head, trunk, vocalization or arrest of speech b) SENSORY sz: paresthesias, feelings of distortion of an extremity, vertigo, smells, tastes, auditory, visual phenomena (flashing lights) c) AUTONOMIC sz: epigastric rising sensation, sweating, piloerection, pupillary changes - - Focal seizures without impairment of consciousness may display deja vu, hallucinations, affect changes - - Focal seizures with impairment of consciousness may display repetitive actions GENERALIZED Seizures: - - consciousness may be impaired, motor activity is bilateral - - seizures can be convulsive or nonconvulsive - - nonconvulsive = absent seizures-staring off 4. Dx: EEG and Observation, MRI 5. Tx: Depends on frequency of seizures and type
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Post-Traumatic Seizure (category is seizures) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: Head injury, the more severe-the longer at risk 2. Pathophysiological insult/ Common Causes: associated with the pathological changes seen in brain injuries: reactive gliosis, axon retraction balls, wallerian degeneration, microglial scar formation, cystic white matter lesions 3. Clinical Manifestations: - - Majority have onset within 2 years of injury, - - description of seizure is dependent on the area that was injured 4. Dx: History, Head Imaging, EEG 5. Tx: Anti-epileptics
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Febrile Seizures (category is seizures) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: - - Peak incidence is 12-18 months, most patients are between 3mos to 6yrs - - High fever - - Viral infection - - Recent immunizations (DTP, MMR) - - Family history 2. Pathophysiological insult/ Common Causes: Seizures occur due to the HEIGHT OF FEVER not the rate of rise. 3. Clinical Manifestations: - - Usually occur within the first 24 hrs of illness - - SIMPLE febrile sz: <15 min-usually 3-4 minutes, do not recur in 24hrs - - GENERALIZED seizure is the most common but can have atonic and tonic spells, return to baseline quickly, SHORT POST-ICTAL time -- COMLEX febrile sz: focal onset, >15 minutes or recurrent in 24 hrs, Can have todd's paresis: transient hemiparesis 4. Dx: H&P; if patient returns to normal then no further work up is needed unless exam dictates 5. Tx: Supportive care, no anti-epileptics
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Infantile Spasms (category is seizures) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: - - majority present at <1yoa, peak is 3-7 months - - associated with: a) CNS malformations, tuberous sclerosis, neurofibromatosis, chromosomal abnormalities, inborn errors of metabolism, congenital infections, b) PERINATAL CAUSES such as hypoxic ischemic encephalopathy c) TRAUMATIC INJURIES such as near drowning, CNS infections 2. Pathophysiological insult/ Common Causes: unknown 3. Clinical Manifestations: -- spasms involve the neck, trunk and extremity muscles, (extensors spasms, flexor spasms or mixed) -- usually symmetric and synchronous -- can have a JACK-KNIFE appearance -- usually in two phases --> sudden and brief spasm of 1 or more muscle groups followed by longer tonic phase -- spasms occur in clusters, 2-125 per cluster with as many as 13 clusters per minute -- intensity increases to a peak and then declines, -- clusters can last for several minutes, usually a behavioral change occurs before -- more frequent in the waking state or daytime -- most patients have neurodevelopmental delay cognitive delay 4. Dx: EEG --> looking for Hypsarrhythmia = disorganized, chaotic pattern of brain waves that occurs in children with infantile spasms (IS) but not in other seizure disorders 5. Tx: ACTH is the first line therapy, vigabatrin can also be used as well as ketogenic diet
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Group A Strep Pharyngitis (category is sore throat) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: School age children 2. Pathphysiological insult/ Common Causes: Spread through contact with mucus from the nose or throat of ill people. 3. Clinical Manifestations: Scarlitiniform rash, Palatal petechia, Pharyngeal exudate, Vomiting, Tender cervical nodes, Fever, Headache, Abdominal Pain, Nausea, sore throat 4. Dx: Rapid strep test and throat culture 5. Tx: amoxicillin or PCN IM * Risk of rheumatic fever if not treated
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Peritonsillar Abscess (category is sore throat) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: most frequent in adolescents 2. Pathophysiological insult/ Common Causes: - - Generally preceded by TONSILITIS or PHARYNGITIS and progresses to an abscess - - Usually occurs in the superior pole of the tonsil, between the tonsillar capsule, the superior constrictor and the palatopharyngeus muscle - - Most common etiology: Group A strep, Staph Aureus, Streptococcus Anginosus, and respiratory anaerobes 3. Clinical Manifestations: - - Severe sore throat, usually UNILATERAL, fever, hot potato or muffled voice, pooling of saliva or drooling, - - Trismus (lockjaw), neck swelling and pain, ipsilateral ear pain, - - Swollen and fluctuant tonsil with deviation of the uvula to the OPPOSITE side OR fullness or bulging of the posterior soft palate near the tonsil with fluctuance, - - Cervical lymphadenopathy 4. Dx: Exam and CT scan 5. Tx: Drainage, Clindamycin so anaerobic coverage is included
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Mononucleosis (category is sore throat) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: Typically occurs in adolescents 2. Pathophysiological insult/ Common Causes: spread through bodily fluids, primarily saliva 3. Clinical Manifestations: - - fever, EXUDATIVE pharyngitis, anterior and posterior cervical or diffuse lymphadenopathy, **splenomegaly, hepatitis, fatigue, anorexia, weight loss - - course is longer when compared to other causes - - rash when ampicillin or amoxicillin is given - - atypical lymphocytes on smear 4. Dx: MONOSPOT test: detects HETEROPHILE antibodies SEROLOGY: IgM and IgG for viral capsid antigen are + *See other references for specifics 5. Tx: Supportive care
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Retropharyngeal Abscess (category is sore throat) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Condition: Children 2 to 4 years of age associated with hx of URI, pharyngeal trauma, pharyngitis 2. Pathophysiological insult/ Common Causes: Often a poly microbial infection, GAS, Staph Aureus, and anaerobes are the most common 3. Clinical Manifestations: - - Dysphagia, odynophagia, drooling, DEC neck extension - - Torticolis- unwillingness to move neck due to pain, - - Respiratory distress-- stridor, Trismus (lockjaw) - - Neck swelling, mass or lyphadenopathy - - May see midline or UNILATERAL swelling of the posterior pharyngeal wall 4. Dx: Exam and imaging with CT 5. Tx: Surgical drainage and clindamycin, for anaerobic and strep coverage
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Congenital Adrenal Hyperplasia (CAH) (category is Vomiting) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: CYP21A gene mutation 2. Pathophysiological insult/ Common Causes: - - 21-hydroxylase deficiency due to a mutation in the CYP21A gene inhibits the conversion of 17-hydroxyprogesterone to 11-deoxycortisol when is then converted to cortisol - - Also inhibits the conversion of Progesterone all the way to aldosterone -- >causes decreased cortisol and aldosterone synthesis causing an increase in ACTH production causing more adrenal stimulation and androgen production - - Severity (salt losing/non salt losing) of disease depends on the amount of 21-hydroxylase available 3. Clinical Manifestations: Three main types of presentations: --->1. Females with salt losing or non-salt losing who present with ambiguous genitalia (enlarged clitorus, labial fusion, formation of urogenital sinus) --->2. Males with salt losing FTT, dehydration, hyponatremia, hyperkalemia at 7-14 days of life -->3. Males with non-salt losing form present at 2-4 years of age with early virilization 4. Dx: High levels of 17-hydroxyprogesterone 5. Tx: Glucocorticoid replacement and other hormones as needed
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Pyloric Stenosis (category is Vomiting) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: 3-5 weeks of age More common in males May have family history 2. Pathophysiological insult/ Common Causes: Hypertrophy of the pylorus causing partial gastric outlet obstruction 3. Clinical Manifestations: - - IMMEDIATE vomiting after feeds that is NONBILLIOUS and forceful/projectile - - Infant acts hungry after - - Palpation of an "olive" mass may be felt in the abdomen - - Hypochloremic metabolic alkalosis, may see hypokalemia 4. Dx: Ultrasound of pylorus 5. Tx: Pylormyotomy, correct electrolyte imbalances
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Diabetic Ketoacidosis (DKA) (category is Vomiting) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: Type 1 Diabetes 2. Pathophysiological insult/ Common Causes: - - Insulin deficiency allows for glucagon to go unchecked and gluconeogenesis to occur - - Further, glucose is not utilized by the body effectively - - Lipolysis occurs in DKA, fatty acids are transported to the liver and are delivered to the mitochondria as Acyl-CoA and then split into acetyl-CoA and then formed into acetoacetic acid (KETONES) - - Accumulation of beta hydroxy butyric acid and acetoacetic acids causes metabolic acidosis - - Hyperglycemia increases the serum osmolarity which draws water out of the cells and dilutes the sodium, this is balanced by an osmotic diuresis which causes excretion of water, which raises the sodium back up - - Potassium stays in the normal range because of two processes: 1. Potassium is lost during osmotic diuresis 2. When the serum osmolarity increases and water moves extracellularly potassium moves with it, balancing what is lost in diuresis 3. Clinical Manifestations: - - Range of symptoms depending on severity and age - - polyuria, polydypsia, tachycardia, fatigue, weight loss, nocturia, daytime enuresis, Polyphagia - - Kussmal breathing: deep fast breathing - - Drowsiness to coma, serum glucose >200, serum bicarbonate <15 or venous pH <7.3 4. Dx: Exam and lab findings with history 5. Tx: Insulin and electrolyte and fluid management
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Eating Disorder (category is Vomiting) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________
1. Predisposing Conditions: Predominantly females Late adolescent 2. Pathophysiological insult/ Common Causes: unknown 3. Clinical Manifestations: Anorexia Nervosa: restriction of food intake, intense fear of gaining weight, distorted body image ``` Anorexia: CV: Bradycardia Gyn: amenorrhea GI: gastroparesis, bloating, constipation Derm: lanugo ``` Bulemia Nervosa: Episodes of binge eating with inappropriate methods implemented to not gain weight Bulimia Nervosa: Parotic and submandibular glad hypertrophy Mallory-Weiss tears Dehydration Hypokalemia Hypochloremia Metabolic alkalosis tooth enamel loss on the lingual surface of teeth scarring or calluses on the dorsum of the hand due to gagging
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Cataracts (category is White Pupillary Reflex) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: - - 1/3 are congenital/genetic - - 1/3 are associated with systemic disease - - 1/3 are idiopathic/sporadic Specific causes: - - ocular trauma-penetrating injuries, long-term steroids, metabolic disorders, craniofacial syndromes, -- CNS disorders, Dermatologic disorders, Muscular disorders - - chromosomal disorders (Tri 21, Turner, Edwards, Cri Du Chat) - - intrauterine infection---> CMV, rubella, toxoplasmosis, HSV, Varicella, Syphillis 2. Pathophysiological insult/ Common Causes: Unknown 3. Clinical Manifestations: - - asymmetry of the red light reflex, leukocoria, nystagmus, strabismus-eyes don't track in the same direction, delayed development, photophobia 4. Dx: Exam, other work up as needed 5. Tx: Surgical
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Retinoblastoma (category is White Pupillary Reflex) 1. Predisposing Condition 2. Pathophysiologic Insult/ Common causes 3. Clinical Manifestations ________________________ not part of traditional illness script 4. Dx 5. Tx
1. Predisposing Conditions: - - Most common primary intraocular tumor - - median age at diagnosis is 18 mos, majority present before 5yoa - - may have a family history 2. Pathophysiological insult/ Common Causes: GENETIC: mutations in the retinoblastoma (Rb) gene, predominantly bilateral presentation, risk for developing future malignancy in life, SARCOMA **SPORADIC: majority cases Retinoblastoma gene is a tumor suppressor 3. Clinical Manifestations: Leukocoria, strabismus, nystagmus, red eye 4. Dx: Exam 5. Tx: Surgical

Pediatrics (1 decks)

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