Midterm Flashcards by Piper Dobner

this is considered positive if there is ANY inequality of color - what is it?

Red Reflex

MUST be performed on all children to assess the eye.

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This is considered an ophthalamic emergency as it leads to vision loss - what is it?

congenital cloudy cornea
- req. surgery by 3-4mos

causes:

glaucoma
trauma
scleroderma
rhabdomyosarcoma

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when the visual axis of the eyes are non-parallel - what is this called?

strabismus

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when does coordinated movement of the eye develop?

by 3-6mo
when infants begin using binocular vision

if deviated 6+ mo; refer for eval

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there are two types of strabismus - what are they?

exotropia - eyes are divergent

esotropia - eyes are crossed

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there are two potential causes of strabismus - what are they?

supranuclear - visual cortex

infranuclear - extraocular muscles or their nerves

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this is a term for loss of vision

amblyopia

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approximately 50% of children with strabismus under 9 years of age will develop this if the eye is left untreated - what is it?

amblyopia - loss of vision

current treatment is patching preferred eye.
chronic strabismus can be disfiguring

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this is a stricture of the nasolacrimal duct, often resulting from a congenital abnormality - it presents between which ages as a persisting tearing of one or both eyes?

Dacrostenosis

presents b/w 3-12 wks of age
usually UL

generally resolves spontaneously by 6mo age

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this is an infection of the lacrimal sac, usually secondary to dacrostenosis. It presents as pain, erythema and edema about the lacrimal sac. There is often tearing and conjunctivitis - what is this?

dacrocystitis

managed with warm compresses, eye wash or topical antibiotics
parents can milk contents of lacrimal sac through the nasolacrimal ducts with fingertip massage (BID)

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for conjunctivitis - there are three etiologies - differentiate them according to the discharge

bacteria - mucopurulent d/c with eyelid swelling (usually staph)

viral - watery, clear d/c, minimal eyelid swelling (gen. follows URI)

allergic - clear, mucoid, ropy d/c, moderate to severe lid edema, itchy

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for conjunctivitis - there are three etiologies - differentiate them according to how many eyes are gen. involved

bacterial - UL, may spread to BL

viral - BL

allergic - BL

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this type of cellulitis presents with edema and swelling of the upper and lower eyelid, presenting with fever and pain - it’s generally UL or BL? - what is it?

periorbital cellulitis (UL)

it involves the eyelid AND surrounding skin

Tx with antibiotics, gen IV

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this type of cellulitis presents with a swollen eyeball that bulges and decreased movement of the eye with decreased vision - what is this?

orbital cellulitis

involves the periorbital and orbital contents

REQUIRES IMMEDIATE REFERRAL for IV ANTIBIOTICS
- augmentin generally

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what two things can cause periorbital or orbital cellulitis? What are potential sequelae we need to be aware of?

etiology

trauma/bug bite (gen staph aureus or strep pyogenes)
internal infxn: sinusitis/bacteremia (gen. h. influenza type b or strep pneumonia)

sequelae

retinal damage d/t ischemia
meningitis, brain abscess

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this is an inflammation of the lid margins with erythema, thickening and crusts, scales or shallow marginal ulcers - loss of eyelashes may be present - what is this?

blepharitis

herbal eyewash, antibiotics, homeopathy
prevent recurrence

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this is an acute, localized pyogenic infection of one or more of the Zeis or Moll or Meibomian glands - generally caused by staph - it presents with pain, redness and tenderness - may find small areas of induration or an internal or external “head” - what is it?

Hordeolum (stye)

tx with hot packs for 10 mins TID; homeopathy
RARE to tx with antibiotics

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if one parent has allergies vs if both do - what are the chances of the child developing allergies?

one parent - 30% chance

both parents - 70% chance

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when supine - rhinitis causes which two symptoms?

post-nasal drip
cough

can be assoc w/ eustachian tube obstruction

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rhinitis is, in general - associated with what?

URI

d/c can be clear to white to yellow to green
thin or thick

can be chronic during WINTER months

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an infant presents to your office sticking its tongue out, maybe displaying a shallow cough and is avoiding swallowing - what may this be?

sore throat
gen. viral etiology

usually associated with URI sx

coryza
conjunctivitis
malaise
hoarseness

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if a child presents with sore throat and a LOW-GRADE fever, what does this suggest?

viral pharyngitis

may also present with:

mouth-breathing
vomiting
abd. pn
diarrhea

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this virus generally presents with red papules, vesicles and ulcers on the tongue, buccal mucosa, palate, gingival and uvulo-tonsillar pillars.
Often you’ll see 2-10 lesions that persist x1wk. Additional papule or vesicular exanthema on hands and or feet (sometimes also on the arms, legs, BUTTOCKS and face) with mild constitutional sx - what is this?

Coxsackie virus

- Hand, Foot and Mouth

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you see small, red papules, vesicles and ulcers ont he posterior oropharynx - with a high fever - what do you suspect this to be?

herpangina

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this infxn presents with pharyngeal injection w/ exudate. Posterior cervical lymphadenopathy and hepatosplenomegaly common. what is this?

Mononucleosis - common in 15+ yrs of age - rapid strep neg

This is the most clinically significant cause of sore throat in kiddos - what is it

Group A Beta Hemolytic Strep (GABHS) - mc in kids 5-15 yrs SX include: - fever - HA - pharyngitis - N/V, abd. pn

child ptc with symptoms of moderate to severe pharyngeal erythema, edema and tonsillar enlargment. Exudate is present. cervical lymphadenopathy is palpated and palatine petechiae are present - what is this? How will you work it up?

GABHS - rapid strep (95% sp, 50-80% sen) - aerobic culture if rapid test was neg (90% sen) Standard of Care is oral penicillin, amoxicillin, etc HEMP tincture, hydro, homeopathy

If a child is treated for strep with antibiotics, how long do they have to wait to return to school?

24 hours after initiation of treatment

This is a complication of strep. It presents as a sandpaper rash d/t hypersensitive to the strep pyrogenic toxin. The rash appears as fine, maculopapular w/ sandpaper texture and erythematous base. BLANCHES w/pressure and desquamates after 7-21 days. Begins on the trunk and spread over body. What is this?

Scarlett Fever

This is a complication of strep. It should be suspected in ANY pt with jt swelling, subcutaneous nodules, erythma marginaturm or HEART MURMUR w/ PMHx of strep within last month

Rheumatic fever

This is a complication of strep. It results from accumulation of purulence in the tonsillar fossa - what is it? And what would you expect to see on PE?

peritonsillar abscess - edema may lead to compromised upper airway. PE will show - UL* peritonsillar fullness or bulging of the posterior superior soft palate with - UVULAR DEVIATION REFER IMMEDIATELY FOR incision and drainage of the abscess; IV antibiotics

This is a complication of strep. It's a RARE infection occurring in the potential space posterior to the pharynx. Abscess occurs subsequent to lymph drainage or localized bacterial spread. Hx reveals sore throat, fever, neck pain/stiffness, poor oral intake. What is this and what would you expect to see on PE?

Retropharyngeal Abscess PE - neck mass OR retropharyngeal bulge. WARRANTS IMMEDIATE REFERRAL

This is a complication of strep. It is an acute, LIFE-THREATENING bacterial infection. Hx will reveal ABRUPT HIGH FEVER, sore throat W/O URI sx. Child will appear toxic quickly with respiratory distress. PE reveals anxious child with chin hyperextended, DROOLING, slow and labored respiration with stridor and retractions. What is this and what should you NOT do?

epiglottitis - MEDICAL EMERGENCY - DO NOT EXAMINE PHARYNX!

Infant presents - crying, poor sleep, FEVER, tugging / digging at their ears. Loss of appetite, V/D and recent HX of URI; whereas older children will report otalgia, worse at night (gen), fever and HL - PE reveals bulging TM obscuring light reflex, loss of bony landmarks and erythema of TM. what is this?

Acute Purulent Otitis Media antibiotics IF - under 2 yrs w/ BL AOM - greater than 3-7 days experiencing otorrhea, pain and fever expect improvement in 24-48 hours - Recheck in 1-2 weeks to monitor resolution

When you think AOM - which homeopathics come to mind?

- belladonna - chamomilla - pulsatilla - kali bic - aconite - calc carb

Upon visualization, you see a TM that is: clear, amber or gray, retracted - with a fluid line or bubbles. What is this condition that may lead to hearing loss if not handled properly

OM w/ Effusion (OME)

when do you refer an OM to an ENT (2)?

- effusion persists despite tx - recurrent AOM, resistant to tx discuss ear tubes (tympanostomy)

when is tympanostomy indicated with OM? (6)

- HL - speech delays - concomitant infections - infections (tonsilitis, enlarged adenoids) - snoring, apnea - severe URIs,

this appears as white lesions behind the TM -

cholesteatoma

pt presents with their ear, lifting away from their head. They have swelling and tenderness post-auricular, with swelling. What is this?

Mastoiditis

this infection lodges in valves and the inner lining of the heart. It commonly presents with FUO (fever of unknown origin)

Subacute Bacterial Endocarditis (SBE) | - definitive blood culture dx's

this idiopathic dz of young children - affects multiple systems with complications mainly related to vasculitis. Characterized by fever of 5+ days, erythema of extremities and edema. rash (non-vesicular) and conjunctivitis . It affects kiddos under 5 yrs. Sometimes, it's atypical.

Kawasaki Syndrome | - mucocutaneous lymph node syndrome

what are the three phases of Kawasaki Syndrome?

acute (1-2 wks from onset) subacute (3-8 wks) convalescent (4 mos, gen)

these are deep grooved, horizontal lines on the fingernails or toes - a common characteristic of what condition?

Beau lines - Kawasaki Syndrome (fever, swelling, desquamation, oral lesions)

what is the biggest complication we're concerned about with Kawasaki syndrome?

aneurysm others: pancarditis, pericardial effusion, death

if an infant presents with signs of - orthopnea (trouble breathing while lying), -SOB, - tachypnea (N HR 120-160) - sweating with breast feeding (mild exertion) what needs to be on your radar?

CHF grayish color cyanosis (central) gen. heart defect (right to left shunt)

This is the most common murmur in newborns

peripheral pulmonary stenosis - benign - grade I-II1 - can resolve

this is an abnormal opening between atria. L to R shunting is usually involved. 1/5000 births - COMMON IN TRISOMY 21.

Atrial Septal Defect (ASD) grade III or lower

this murmur of infants is most common in - preemies - high altitudes and - females

Patent Ductus Arteriosus (PDA) gen. resolves spontaneously if still present in 6-8 wks, refer to cardiologist

this heart defect requires surgery - child may experience spells, poor growth, marked dyspnea - and gradual onset of cyanosis from R to L shunting - what is it?

Tetrology of Fallot 4 defects combined - pulmonary stenosis - VSD - overriding aorta (dextroposition) - hypertrophy of R ventricle

syncope is a common first presenting sign in school age children for this ambiguous heart defect - which is MC?

arrhythmias MC - supraventricular tachycardia (SVT) irregularly irregular on PE - sinus arrhythmia coinciding w/ respiration - BENIGN - PAC - PVC

you have a child present with a HR greater than 200bpm, what is on top of your DDX?

supraventricular tachycardia

is a persistent cough ever normal in an infant?

No. infants with URI more concerning than older kids - RSV - HiB

which has a fever, URI or LRI?

LRI | - generally going to look more sickly

this is characterized by a deep barking cough, and INSPIRATORY stridor - night time cough. child <4yrs

Croup (laryngotracheobronchitis) - late fall, early winter ``` HYDRO!! homeopathics to consider: - spongia - aconite - hepar sulph (later progression) ```

this highly contagious infection presents with frequent bursts of coughing followed by high-pitched inspiratory whoop

pertussis - bacteria, bordatella pertussis - kid looks sick

this is a breath sound caused by air passing over retained airway secretions (mucus), or sudden opening of collapsed airways - what is it?

rale/crackle

these are wheezing noises heard during ONE OR BOTH inspiration or expiration

rhonchi

this breath sound is continuous, musical

wheeze

when we see tachypnea on PE - what are we thinking immediately?

LRI - bronchitis - labs aren't that useful TEAS!

rapid onset, toxic appearance, severe INSPIRATORY stridor, drooling and sore throat - toxic looking, LOW GRADE FEVER what is this and what's the most common causative agent?

Bronchiolitis - MC cause RSV incubation (2-4 days) shed (20 days post infection)

this is often preceded by URI, productive cough, SOB, dyspnea, fever, HA, malaise, lethargy - what are you thinking?

pneumonia PHOS* homeopathic tachypnea will be present on PE CXR, then repeat >6wks after

this is a commonly prescribed B2 agonist (short acting) for asthma

albuterol (ventolyn, proventil)

what does it mean to have a baby with colic?

- excessive crying episodes - no apparent reason - MC <3 mos old theories of cause - abd. pn - milk allergy - attempt to communicate wants and needs usually resolves x3mos

what are some common homeopathics for colic babies?

``` chamomilla pulsatilla colcynthis dioscorea nux vomica lycopodium ```

characterized by injury to the proximal small intestine resulting in vomiting and WATERY diarrhea - this presents with low grade fever - PE reveals increased bowel sounds. what is this?

viral gastroenteritis - abrupt onset, limited duration - MC rotavirus - 48-72hr incubation, V/D x2-8days DEHYRDATION RISK*

this condition rarely occurs under 3 years of age. It presents with peri-umbilical pain, N/V and low grade fever. Constipation, rectal tenderness that progresses to RLQ tenderness (12-24 hrs)

Appendicitis - most rupture within 48 hrs of onset homeopathics - belladonna - bryonia

this telescoping of an intestinal segment - generally occurring with invagination of the ileum through the ileocecal valve into the color - has sudden onset of crampy, abd pain. occurring at 3-24 months (peak 6-12mo)

Intussusception | - guaiac or currant jelly stool*

this generally consists of a mass of matted hair in the stomach (gag)

gastric bezoars

is dairy ok with viral gastroenteritis?

no can lead to post-infectious secondary lactose intolerance

this type of gastric infection can cause colonic inflammation that leads to crampy abd. pn and stools with blood or mucus - what is it?

bacterial gastroenteritis

this intestinal abnormality of innervation is due to the absence fo meissner and auerbach plexuses causing partial or complete bowel obstruction

Hirschprung Disease | - 80% present with failure to pass meconium by 48 hrs of life

what are the most important signs of abd. pain or a significant intra- abdominal process in infants (5)

- vomiting - diarrhea - anorexia - irritability - drawing up of the legs

what are the time frames and primary sources of nutrition from birth to 12 months.

0-6 mo - no solids, primarily breast/formula 6 mo - increased movement, introduce solid foods, diversity not important, iron rich; breast feeding still primary source 9 mo - starting to move more, more food, start becoming more complex 12 mo - walking means higher energy need Fats are critical!

what is typical weight gain in the first 6 months? the following 6 months?

first 6 mos - 20-30gm/day | second 6 mos - 15-25gm/day