Pediatrics Exam 2 Flashcards
(84 cards)
1
Q
Congenital Melanocytic Nevi
Definition
A
proliferation of benign melanocytes
2
Q
Congenital Melanocytic Nevi
Presentation
A
- Macules, papules, plaques present at birth
- +/- hair
- may change w/ time
- grow in proportion to size
3
Q
Congenital Melanocytic Nevi
Malignancy risk
A
- Small/medium CMN have < 1% risk of malignancy
- Large/Giant lesions 0-7.6% risk. Avg. is 2%
4
Q
Mongolian Spot
Definition
A
Congenital Dermal Melanocytosis
5
Q
Mongolian Spot
Presentation
A
- Most common pigmented lesion in infants. fade by 2 y/o, disappear by 10
- bluish-grey patch
- irregular border and normal texture
- buttocks, low back
- Asian, black, hispanic
- Present at birth, evident in 1st weeks
6
Q
Nevus Sebaceous
Definition
A
- hyperplasia of epidermis, sebaceous glands, hair follicles, apocrine glands
7
Q
Nevus Sebaceous
(Presentation
A
- scalp/face
- waxy, solitary, smooth, yellow-orange, hairless
- oval/linear
- more pronounced in adolescence
8
Q
Nevus Sebaceous
Dx
A
- atypical = histological eval
2. BCC or other malignancy may arise from lesion
9
Q
Nevus Sebaceous
Tx
A
- only if concerning changes observed
10
Q
Aplasia Cutis Congenita
Definition
A
- absence of skin present at birth
2. localized or widespread
11
Q
Aplasia Cutis Congenita
presentation
A
- midline, posterior scalp
- +/- bulla
- +/- other dev abnormalities
- well demarcated
12
Q
Aplasia Cutis Congenita
Tx
A
- size, depth, location dependant
- gentle cleansing, ointment
- hypertrophic scarring
- neurosug referr for large/multiple defects
13
Q
Cafe-Au-Lait Macules
Presentation
A
- Discrete, uniformly pigmented macules/patches
- M/c in AA, hisp, asian, white
- present at birth, early childhood
- associated w/ macune-albright or NF1
14
Q
NF1
A
- cafe-au-lait macules
- axillary/inguinal freckling
- neurofibromas
- lisch nodules
- optic gliomas
15
Q
Port-Wine Stain
Definition
A
- cutaneous capillary malformation
16
Q
Port-Wine Stain
Presentation
A
- present at birth, no regression
- pink, dark red patches that may get darker
- associated c soft tissue, bony overgrowth. sturge weber syndrome, congenital glaucoma
17
Q
Port-Wine Stain
Management
A
- depends on size, location, cosmetic impact
- pulse dye laser: intravascular coagulation
- Vascular specialist if widespread
18
Q
Infantile Hemangioma
Definition
A
- common benign vascular tumor
2. Risk factors: low birth weight, female, twins, fair skin
19
Q
Infantile Hemangioma
Presentation
A
- appears shortly after birth
- superficial, deep or mixed: superficial = bright read, deep = bluish border
- Ulceration common complication
20
Q
Infantile Hemangioma
Progression
A
- proliferative phase: Early
- rapid growth during 1st 3 months - Proliferative phase: late
- less rapid, still ongoing
- completed typically by 9 mo - Involution Phase: color darkens, tumor softens.
21
Q
Nevus Simplex
Presentation
A
- faint, transient
- flat, pink/red patch
- midline forehead, scalp, upper eyelids, posterior neck and back
- “stork bite” or “angel kiss”
- most common pediatric vascular lesion
- fade w/in 1-2 years
22
Q
Pyogenic Granuloma
presentation
A
- acquired lobular vascular tumor
- hands, fingers, face, mucous membranes
- develop rapidly
- extremely friable
- recur despite tx
23
Q
Pyogenic Granuloma
Tx
A
- biopsy to confirm dx
- surgical excision w/ primary closure - high risk of recurrence, tx is traumatic
24
Q
Diaper Dermatitis
Definition
A
- irritant/contact dermatitis
2. may be caused by seborrheic dermatitis, atopic dermatitis
25
Diaper Dermatitis
| Pathogenesis
1. excessive moisture, friction, increased pH
| 2. macerated skin, infx from urine/feces
26
Diaper dermatitis
| Presentation
1. Episodic, varying severity
2. candidal superinfection: beefy red plaques in intertriginous regions
3. Impetigo: s. aureus/pyogenes. fragile honey crusted pustules/erosions
27
Diaper Dermatitis
| prevention
1. frequent diaper changes
2. air exposure
3. gentle cleansing
4. fragrance free baby wipes
28
Diaper Dermatitis
| Tx
1. OTC pasts, ointments
2. low-potency topical CS
3. breast milk
4. antifungals
5. topical/systemic abx
29
Neonatal Cephalic Pustulosis
1. Not true acne - malassezia colonization
2. self-limited
3. present first 2-3 weeks, resolves by 6-12 months
30
Neonatal acne
| Presentation & Tx
1. no comedones
2. Presents w/ papules pustules on forehead, nose cheeks
Tx: mild cleansing w/ soap and water.
Ketoconazole, hydrocortisone
Resolves by 4 mo
31
Infantile Acne
| Presentation
Presents at 3-4 mo, resolves by 2-3 y/o
hyperplasia of sebaceous glands
papules, pustules, comedones
32
Infantile Acne
| management
benzoyl peroxide, topical abx, topical retinoids
oral tx in severe cases
33
What differentiates periosteum in pediatric pts?
More metabolically active
thicker and more durable
34
Common fx types in pediatric patients?
buckle/torus, greenstick, bowing
35
CRITOE, 1, 3, 5, 7, 9, 11
1 - Capitulum
3 - Radial Head
5 - Internal epicondyle
7 - trochlea
9 - olecranon
11 - external epicondyle
36
Most common elbow fracture, occurs under 10 y/o.
MOI: FOOSH from moderate height (monkey bars)
Swelling, Pain, +/- deformity
Supracondylar humeral fx
NV exam critical to asses median nerve
37
Diagnostics for supracondylar fx
X Ray: AP, lateral, oblique. Ant. humeral line should intersect capitulum
38
Supracondylar fx management
Type I/II: splint w/ light overwrap.
Type III/NV concerns: emergent ortho consult. CRPPF
39
Concentrated soft tissue swelling at lateral elbow
Tender palpation over lateral condyle
X-Ray shows small Fx
Lateral humeral condyle fx
40
Lateral humeral condyle fx diagnostics
X-Ray: AP, lateral, internal oblique
+/- MRI
41
Management of lateral humeral condyle fx
- splint, sling, NSAIDs
- Emergent ortho consult if displaced >2mm on internal oblique view
- Immobilization via cast or ORIF
High risk of complications
42
MOI: muscle attachment avulsion from throwing athletes/gymnasts, FOOSH, posterior elbow dislocation
Presents w/ local pain, pain w/ resisted wrist flexion, ulnar nerve dysfunction
Medial Humeral Epicondyle Fx
43
Diagnostics for medial humeral epicondyle fx
X-Ray: AP, lateral, external oblique.
Rule out incarceration of fragment in joint
44
Management of medial epicondyle fx
- emergent if entrapped fragment
- Splint w/ wrist and sling
- NSAIDs
45
Complications of medial epicondyle fx
ulnar n. injury
nonunion
angular deformity
decreased ROM
46
MOI: FOOSH w/ valgus stress, posterior elbow dislocation
Presents w/:
- tenderness over radial head/neck
- pain w/ supination/pronation more than flexion/extension
- young children may complain of wrist pain
Radial neck fx
47
Diagnostics for radial neck fx
X-Ray: AP, lateral and external oblique
Clinical if radial head not ossified (3-5 years)
48
Management of radial neck fx
immobilization including wrist.
sling
NSAIDs
Cast v. surgery
49
complications of radial neck fx
premature physeal closure
loss of ROM
nonunion
50
Subluxation of radial head between age 1 and 3
MOI: sudden pull of pronated arm.
Presents w/:
- fully extended, pronated arm
- won't use arm, but will use fingers
- pain over radial head, increased w/ supination
Nursemaid's elbow
51
Management of nursemaid's elbow
1. reduction via hyperpronation or supination/flexion
| 2. f/u w/ lollipop test
52
MOI: FOOSH, direct trauma
Common on distal radius at metaphysis +/- ulnar involvement
Presents w/:
-point tenderness, swelling, ecchymosis
Wrist fx
53
Diagnostics for wrist fx
X-Ray: AP/Lat +/- oblique
SH I clinical diagnosis
54
Management of wrist fx
emergent w/ significant deformity or N/V compromise
Splint and NSAIDs
Ortho: cast, +/- reduction/surgery
55
Trauma, pain in groin/buttock
NWB, non-ambulatory
leg helt in slight adduction w/ external rotation
may see shortening of limb
Femur fx
56
Diagnostics for femur fx
X-Ray entire length of femur
57
management of femur fx
hip spica cast or surgery
58
complications of femur fx
shortening, lengthening, angulation deformity
59
Unique fx to children, post common in kids < 13 y/o
MOI: forced extension w/ knee if flexion (jumping, kicking
Presents at superior or inferior pole of patella
special fx of the patella/patellar sleeve fx
60
management of patellar sleeve fx
knee immobilizer
nwb
elevation
nsaids
ortho: cast v. surgery
61
MOI: falling while running/twisting motion. Slides
Presents w/:
- limp or refusal to weight bear
- presumed foot injury
- pain w/ palpation along tibia mid to distal diaphysis
Toddler fx
62
diagnostics for toddler fx
X-Ray: AP, lateral, obliques
63
MGMT of toddler fx
immobilization
nwb
nsaids
elevation
Ortho: wee walker vs casting
64
MOI: external rotation
Presents w/:
-Type III on AP, type II on lateral = type IV
triplane fx
65
management of triplane fx
must get CT.
Ortho: surgical fixation vs closed reduction
posterior or stirrup splint
elevation, nwb, nsaids
PT
66
Scoliosis degree of curvature and common ages
greater than 10 degree curve
Adolescent 10 or older
67
Physical exam for scoliosis
- shoulder or pelvic obliquity
- asymmetry of scapulae
- adam's forward flexion exam
68
Imaging for scoliosis
cobb angle analysis
AP/PA standing plain radiograph on long cassette
69
Tx for scoliosis
boston, milwaukee, charleston bending braces
Surger indicated if 45 degrees
70
Age : 0-3mo or 3-6 y/o
male prevalence greater than female
hx of trauma or surgery
appears toxic w/ fever, monoarticular pain exacerbated w/ passive ROM, nwb
Septic hip
71
Age 3-8 y/o, male
afebrile, well appearing
pain worse in am, improves during day
hx of recent uri
transient synovitis
72
Kocher criteria
1. wbc > 12k
2. ESR > 40
3. Fever > 101.3
4. nwb on affected side
2/4 warrants joint aspiration for septic hip
73
Imaging for septic hip
X-Ray: AP, frog-leg and lateral pelvic
Ultrasound: effusion and aspiration
MRI
74
management of septic hip
EMERGENT
Surgical I & D, joint aspiration is diagnostic
Abx: Cephalosporins
If n. gonorrhoeae, high dose penicillin
75
pt. 4-8 y/o, male
Dx w/ ADHD
Presents w/:
- painless limp at end of day
- muscle spasticity
- Hx of minor trauma
Exam reveals:
- antalgic limp/trendelenburg gait
- limited internal rotation/abduction of hip
- + galeazzi
Perthes
76
Imaging for Perthes
X-Ray: AP and frog laterals
Bone scan/MRI
77
Tx of perthes
younger age = better outcome
control of sxs and hip preservation
78
- Male pt, between 10-16 y/o
- Obese, limp or nwb w/ hip or knee pain
- Restricted ROM, abduction and internal rotation
Slipped Capital Femoral Epiphysis (SCFE)
"Ice cream slipping off the cone"
79
Diagnostics for SCFE
X-Ray: AP Pelvis and Frog Lateral
MRI if suspected but neg x-rays
80
Tx of SCFE
urgent surgical consult
if NWB, admit to hospital
81
Female, 1st born, breach pt.
presents w/ laxity, subluxation and dislocation of hip
+ barlow and ortolani w/ clunking sensation
+galeazzi
developmental dysplasia of the hip
82
Management of DDH
Pavlik harness via ortho clinic
avoid swaddling and tight fitting clothes
monitor
X-Ray after 6-7 mo
83
Fixed deformity.
```
midfoot = cavus
forefoot = adducts
hindfoot = varus
hindfoot = equinus
```
fhx, maternal smoking
clubfoot, congenital talipes equinovarus
84
Tx of clubfoot
ponseti casting
