Misc Peds Lecture Flashcards
(88 cards)
1
Q
What is strabismus
A
a anomaly of ocular alignment that can be unilateral or bilateral
2
Q
Types of strabismus
A
eso—> nasal
exo—> temporal
latent=phoria
manifest= tropia
3
Q
Risk factors for primary strabismus
A
- family hx
- low birth weight
- muscle abnormality
- visual deprivation
4
Q
Complications of strabismus
A
- amblyopia
- diplopia
- contracture of extraoccular muscles
- psychosocial and vocational consequences
5
Q
Treatment of strabismus
A
medial:
- glasses
- miotic drops
- patching
- visual training exercises
Surgical:
-repositioning or shortening
6
Q
Impetigo
A
contagious superficial bacterial infection
7
Q
Primary vs secondary impetigo
A
primary- direct bacterial invasion of normal skin (pyoderma)
secondary- infection at site with previous mild trauma (impetigo contagiosa)
8
Q
Who gets impetigo
A
- kids 2 to 5 years old
- warm, humid conditions
- spread easily by close contacts
9
Q
What causes impetigo
A
staph
10
Q
What are the three types of impetigo
A
- non bullous
- bullous
- ecthyma
11
Q
Non bullous impetigo
A
vesicles surrounded by erythema and breakdown and become thick adherent crust with “honey colored” appearance
12
Q
Bullous impetigo
A
vesicles enlarge to form flaccid bullae with clear yellow fluid which becomes darker and ruptures to form thin brown crust
13
Q
Ecthyma
A
ulcerative form of impetigo, causes punched out ulcers w/ yellow crust that is surrounded by raised margins
14
Q
When do you culture fluid from impetigo
A
if treatment fails
15
Q
Topical treatment for impetigo
A
- mupirocin
- h2O2 cream
16
Q
Oral treatment of impetigo
A
use if bullae
- diclox
- cephalexin
- clinda
- bactrim if MRSA suspected
17
Q
Appearance of pin worms
A
small white and threadlike
18
Q
Where do pinworms inhabit
A
- cecum
- appendix
- ileum
- ascending colon
19
Q
Pinworms aka ____ caused by ___
A
eterobiasis caused by enterobius vermicularis
20
Q
Spread of pinworms
A
fecal or oral route
21
Q
Clinical manifestations of pinworms
A
- nocturnal perianal and perineal itching
- visible worms around anus and buttocks
22
Q
Diagnosis of pinworms
A
- hx of nocturnal itching
- collection with cellophane tape or pinworm paddle
- visual inspection of stool or anus
23
Q
Treatment for pinworms
A
- Albendazole: 400mg once and repeat in 2 weeks
- pyrantel pamoate is alternative
- treat family
- practice good hygiene
24
Q
erythema infectiousum aka
A
fifth disease
25
What causes erythema infectiousum
parovirus B19
26
How if erythema infectiousum transmitted
UNKNOWN
| -transmission stops after symptoms develop
27
Symptoms of erythema infectiousum
Day 1-2: fever, headache, nausea, diarrhea
Day 2-5: slapped cheeks, circumoral pallor, reticulated rash on trunk/extremities
28
What things can make the rash in fifth disease reappear
- sunlight
- heat changes
- exercise
- stress
29
Treatment of erythema infectiousum
Supportive only
30
What can parvovirus B19 cause in adults
- transient aplastic crisis
- fetal hydrops--> fetal demise
- arthritis/arthralgia
- chronic symptoms
31
Cause of mono
EBV
32
Transmission of mono
- virus shed in salivary secretions
- found but not transmitted in breast milk
- ? sexually transmitted
33
Incubation of mono
4-7 weeks
34
Classic clinical manifestation of mono
- fever
- pharyngitis
- adenopathy
- fatigue
- atypical lymphocytosis
- splenomegaly
- rash
- hepatitis
35
Less common symptoms of mono
- splenic rupture
- guillain barre, CN palsies, aseptic meningitis, transverse myelitis, optic neuritis
- cholestasis
- pneumonia
- myocarditis
- pancreatitis
- mesenteric adenitis
36
Diagnosing mono?
- mostly a clinical diagnosis
- atypical lymphocytes >10% on diff
- heterophile Ab (monospot)
37
What things can turn monospot positive other than mono
- leukemia
- lymphoma
- pancreatic cancer
38
When should you consider an EBV panel
if a pt has sx and findings c/w mono and the heterophile remains negative after retesting 1 week later
39
What should you consider in EBV panel is negative
- CMV
- HIV
- Toxo
- HHV 6 or 7
- Hep B
40
Treatment of mono
- supportive care (hydration, antipyretics)
- steriods if airway compromised by tonsillar hypertrophy
- splenic rupture precautions
41
What are splenic rupture precautions
- 3 weeks mild activity
- minimum 4 weeks for contact/high risk sports and activities
- or longer if spleen remains enlarged by palpation or ultrasound
42
Symptoms of measles
- fever
- cough
- coryza
- conjunctivitis
43
Pathognomonic for measles
Koplik spots
| -maculopapular rash that start at head
44
When is measles contagious
4 days before rash through 4 days after rash
45
Common complications of measles
- OM
- pneumonia/bronchopneumonia
- croup
- diarrhea
46
Less common complications of measles
- acute encephalitis
- respiratory or neuro complication
- subacute sclerosing panencephalitis (occurs 7-10 years later)
47
How are the measles spread
- highly contagious
- direct contacts with droplets or airborne
- remains on surfaces for up to 2 hours
48
Testing for measles
-IgM antibody
-RNA by PCR
via serum or NP swab
can also get urine
49
Poster exposure prophylaxis for measles
-MMR vaccine withing 72 hours of exposure or IG if administered within 6 days of exposure
50
Treatment of severe measles in children (hospitilized). Why?
Vitamin A
- deficiency contributes to delayed recovery and to the high rate of post measles complications
- can also cause xerophthalmia--> childhood blindness
51
Rubella aka
german measles
52
Symptoms of rubella
- rash and low grade fever
| - lymphadenopathy and arthralgia in older kids and adults
53
Complications of rubella
birth defects in pregnant women--> deafness, cataracts, heart defects, developmental delay, liver and spleen damage
54
How is rubella transmitted
airborne
55
Roseola is caused by what
HHV 6 and HHV 7
56
Signs and symptoms of roseola
- sudden high fever (102-104)
- fever subsides and rash appears
- rash trunk to arms and legs
- rash is asymptomatic
57
Kawaskai's disease is also know as what
Mucocutaneous lymph node syndrome
58
What is Kawaskai's disease
widespread inflammation of medium sized blood vessels throughout the body
*most importantly vessels of heart*
59
Who gets Kawaskai's disease
- kids less than 5
| - boys more than girls
60
What causes Kawasaki's disease?
mainly unknown
- possible infectious (winter and summer)
- possibly genetic (asain and asain american)
61
What is seen in vessel walls in Kawasaki's disease
neutrophilic inflitrate
*polymorphocytes then macrophages and lymphocytes
62
Clinical manifestations of Kawasaki's disease
- fever
- conjunctivitis
- mucositis
- rash
- extremity changes
- lymphadenopathy
- cardiovascular findings
63
Fever in Kawasaki's disease
fever over 100.5 lasting 5 days or longer
*kids with a fever for 5 days or longer with no obvious source think Kawasaki
64
Conjunctivitis in Kawasaki's disease
- non exudative
- bilateral
- spares the limbus
can be accompanied by photophobia/uveitis
65
Mucositis in Kawasaki's disease
- crack red lips
- strawberry tongue
*not associated with tonsillar exudate, oral vesicles or ulcers
66
Rash with Kawasaki's disease
- polymorphous
- begins perineal with erythema with desquamations
- then may be macular/morbilliform/targetoid
*not typically vesicular or bullous
67
Extremity changes in Kawasaki's disease
- swelling of hands and feet
- diffuse erythema on palms and soles
- arthritis in large joints
- sheet like desquamination that beings periungual (Beau's lines)
68
Lymphadenopathy in Kawasaki's
- primarily anterior cervical nodes
- typically singular
- typicall large >1.5cm
69
Cardiovascular chages in Kawasaki's disease
on day 5-10: tachycardia out of proportion to fever
- muffled heart sounds
- brachial aneurysms
- cold pale cyanotic digits
70
Later cardiovascular complications of Kawasaki's disease
- coronary artery aneurysm
- myocarditis
- pericarditis
- MI
- arrhythmias
71
Labs that may occur in Kawasaki's
- elevated ESR adn CRP
- elevated platelets
- normocytic/normochromic anemia
- elevated liver transminases
- UA: pyuria without infections
72
What does every patient diagnosed with Kawasaki's disease get
Echo repeated in 4-6 weeks
73
Treatment of Kawasaki's disease
- admit to hospital for monitoring
- monitor specifically for cardiovascular function
IVIG--> reduce aneurysm risk
ASA
Steriods if IVIG fails twice
TNF inhb if IVIG fails twice
74
When should you expect fever to drop after giving IVIG in KAwasaki's
within 36hrs, give second dose if that does not happen
75
Coxsackie aka
hand, foot, mouth
76
What casues coxsackie
enterovirus
77
How is coxsackie spread
fecal oral
78
Most likely presentation of coxsackie
- apthous stomatitis
- rash on hands and feet
- fever
*uncommonly causes aseptic meningitis
79
Treatment of coxsackie
Symptomatically
- tylenol or motrin
- magic mouthwash (benadryl and maalox)
80
Classic varicella
dew drop on a rose petal
81
Chicken pox aka
initial varicella zoster virus
82
Treatment of chicken pox
Symptomatic
- motrin or tylenol
- benadryl or aveeno
if pt is high risk--> acyclovir, valcyclovir
83
Rare complications of chicken pox
- encephalitis
- pneumonia
- bronchitis
- post herpetic neuralgia
84
Eneuresis
involuntary urination
85
Treatment of nocturnal eneuresis
DDVAP--> increases ADH--> decrease urine output
86
Causes of UTI in infants
-anatomical abnormalities: vesicoureteric reflux
think UUTI if URI sxs w/ fever and <3months that is not present with dysuria, hematuria, frequency
87
Causes of UTI in children
- toilet trainign and poor wiping
- constipation
- withholding
88
Causes of UTI in teens
-STI or sexually related until proven other wise
