Peds 1 Flashcards
(277 cards)
1
Q
Viral Particles
A
Small virus particles with no viral DNA
2
Q
Subunit Vaccine
A
Viral proteins only
3
Q
Toxoid
A
Inactivated toxin stimulates antibody production
4
Q
Vaccine Contraindications
A
mod-severe illness regardless of fever, egg or chicken allergy for influenza
Live vaccines: pregnancy and compromised immunity
5
Q
If you don’t get live vaccines together, how long should you wait between?
A
28 days
6
Q
Meningococcal Conjugate Vaccine (MCV4) Schedule
A
First dose: age 11-12
Booster: 16
Vaccinate ALL college students in dorms who don’t have it yet
7
Q
Meningococcal Conjugate Vaccine (MCV4) Contraindications
A
Latex allergy, history of allergy to diphtheria, history of Guillain-Barre
8
Q
Live-Attenuated Influenza vaccine (FluMist) Schedule
A
Yearly age 2-49 if healthy, better in 2-8 than inactivated
Given intranasally
9
Q
FluMist Contraindications
A
Severe allergic reaction, taking aspirin and allergic to eggs, pregnant, immunosuppressed, kids 2-4 with asthma/wheezing in past 12 months, taken flu antivirals in last 48 hours
10
Q
Synagis (RSV prophylaxis)
A
Only given to high risk babies <2
Given monthly through the fall, very expensive
11
Q
Abnormal Vaccine Reactions
A
Inconsolable >3hours, high fever >104-105, seizure, neurological abnormalities, anahylaxis
12
Q
Vaccine Side Effects (normal)
A
Fussiness <3 hours, tired, low fever <101.5, injection site pain, redness, swelling
13
Q
Roseola infantum (erythema subitum) cause and treatment
A
Caused by herpes virus 6 or 7 Treated symptomatically (fever control, fluids)
14
Q
Roseola Infantum Presentation
A
6 months-3 years with abrupt high fever for 3-7 days that stops abruptly followed by rosy-pink maculopapular rash that starts on trunk, not itchy and blanches
Adenopathy and URI findings
15
Q
Erythema Infectiosum (fifth disease) Cause and Treatment
A
Caused by Human Parvo B-19 Treated symptomatically (fluids, antiemetics, etc)
16
Q
Erythema Infectiosum Presentation
A
Mild-mod fever, headache, nausea, diarrhea followed in 2-5 days with “slapped cheeks” and lace-like rash on trunk and limbs
17
Q
Oral Candidiasis (thrush) Casuative agent and treatment
A
Candida albicans
Treated with nystatin suspension, treat mom as needed (if breastfeeding)
18
Q
Oral candidiasis Presentation
A
Adherent white plaques (thrush won’t brush) with underlying red mucosa that will bleed
Decreased feeding
19
Q
Enterobiasis (pinworms) causative agent and treatment
A
Enterobus vermicularis
Treat whole family with 100mg Mebendazole once, repeat in 2 weeks, wash sheets in hot water
20
Q
Enterobiasis Presentation
A
Can be asymptomatic
Anal itching esp at night
21
Q
Enterbiasis Diagnosis/Prevention
A
Scotch tape test
Prevent with hand washing, short nails, avoid scratching anus
22
Q
Molluscum Contagiosum Causative Agent and Treatment
A
Poxvirus
Treat with curettage, cryotherapy, cantharidin, podophyllotoxin, retinoids, salicylic acid, lasers
23
Q
Molluscum Contagiosum Presentation
A
Flesh-colored dome-shaped papule with central umbilication
24
Q
Bacterial Meningitis
A
Emergency, fatal if untreated
25
Bacterial Meningitis Pathogen in 1-3 month olds
Group B strep
26
Bacterial Meningitis Pathogen in 3 months-3 year olds
S pneumoniae
27
Bacterial Meningitis Pathogen in3-10 year olds
S. pneumoniae
28
Bacterial Meningitis Pathogen in 10-19 year olds
N. Meningitidis
29
Bacterial Meningitis Presentation
High fever, irritable, anorexia, headache, confusion, photophobia, back pain, nuchal rigidity
Petechial rash that does not blanch in N meningitides
30
Viral Meningitis
Presents similar to bacterial-it is bacterial until proven otherwise!
31
Humoral immunodeficiency
Impaired antibody(Ig) production
32
Presentation of immunodeficiency
Recurrent severe respiratory infection (OM, sinusitis, pneumonia), poor growth, failure to thrive, unexplained splenomegaly, chronic diarrhea
33
What is the most common immunodeficiency?
Selective IgA deficiency (w/ normal IgG and IgM in a child >4 years)
34
Presentation of IgA deficiency
Most are asymptomatic
Recurrent sinopulm infections, autoimmune disorders, GI infections (giardiasis), allergic disorders, anaphylactic transfusion reactions, celiac
Refer to immunology
35
Common Variable Immunodeficiency (CVID)
Impaired B-cell, T-cell and dendritic cell production leading to impaired Ig production
36
CVID Criteria
Reduced serum IgA, G and M
| Poor response to vaccines, presence of B-cells, absence of other immunodeficiency
37
CVID Presentation
Usually presents around puberty
| Chronic/recurrent rest infections, GI infections, Failure to thrive (diarrhea, malabsorption, weight loss), atopic triad
38
CVID Management
Refer to immunologist, IVIG
39
Severe Combined Immunodeficiency (SCID)
Severe defect in both T and B lymphocyte systems leading to early death from infection
X-linked (males only)
Part of newborn screen in all states
40
SCID Presentation
One or more severe infections in first few months of life, may become ill from live vaccines (varicella, MMR, OPV (polio) or RV (rotavirus))
May not have visible thymus on chest xray
41
SCID Manifestations and Therapy
Persistent thrush, P jirvecii infection, lymphoma, death from viral infections
Stem cell transplant, managed by immunology
42
DiGeorge Syndrome
Chromosomal deletion of 22q11.2 affecting multiple body systems
Most prevalent micro deletion syndrome in US
43
DiGeorge Syndrome Defects/Presentation
Cyanosis (tetralogy of fallout, ASD, VSD, interrupted aortic arch)
Immune dysfunction (Cell deficits, hypo plastic thymus)
Cleft palate
Hypocalcemia (parathyroid hypoplasia, tetany, seizure)
44
Wiskott-Aldrich Syndrome
X-linked disorder caused by mutation in WASp protein
45
Wiskott-Aldrich Presentation
Susceptibility to infections, thrombocytopenia, eczema
| Can develop malignancy, autoimmune disease
46
Wiskott-Alsdrich Treatment
Stem cell transplant is only curative
| Prophylactic antibiotic and antiviral (bactrim+acyclovir), platelet transfusions as needed, Ig if needed
47
Ataxia-Telangiectasia Presentation
Don't develop fluidity of gait, telangiectasis of conjunctiva, face and neck, swallowing problems/aspiration, malignancy (lymphomas), nystagmus
Treat each manifestation individually
48
When are the recommended well visits?
birth, 1 month, 2mo, 4mo, 6mo, 9mo, 12mo, 15mo, 18mo, 2years and then annually
49
What percentiles are considered Overweight, obese and underweight?
overweight: 85-95%
Obese: >95%
Underweight: <5%
50
What are the head size percentiles?
Microcephaly: <3%
Macrocephaly: >97%
51
Birthweight classifications
Extremely low: <1000g/2.2lbs
Very low: <1500g/3.3lbs
Low: <2500g/5.5lbs
Normal: >2500g
52
Classification of gestational age
Preterm: <37 weeks
Term: 37-42 weeks
Postterm: >42 weeks
53
Apgar Score
Key newborn assessment immediately after birth. Retested every 5 minutes until score is >7
54
Newborn Screen
Heel stick before discharge and at 1-2 weeks to test for metabolic and genetic diseases
55
What is vernix caseosa?
Cheesy white covering made from fetal corneocytes and sebaceous gland activity and risk lipid matrix
56
Milia
Pinpoint white papule without surrounding erythema caused by blocked sebaceous glands, disappears on its own
57
Mongolian Spot
Congenital dermal melanocytes; blue patches of pigment seen over lumbar area, buttocks or extremities, fade with time
Common in Asian, both Indians, Mexicans and blacks
58
Erythema Toxicum
Yellow eosinophilic papule on red base that appear on trunk, face and forehead on day 2-4, disappear within 1 week
59
What can abnormal fontanelles indicate?
Bulging: increased ICP
Sunken: dehydration
Large: hypothyroidism
Raised bony ridge: craniosynostosis
60
Cephalohematoma
Swelling/collection of blood over one or both parietal bones, does not cross suture line, resolves in weeks-months
61
Caput Succedaneum
Edema of the scalp, can cross suture lines, resolves in days
62
Epstein's pearls
Small, white benign inclusion cysts typically seen on palate between 2-4months
Bohn nodules seen on gingival ridge
Resolve spontaneously
63
Ankyloglossia
Congenital short lingual frenulum that can limit movement of tongue and pain with nursing
Usually see a puckering of the midline tongue tip
Treat with frenotomy/frenulotomy in neonatal period
64
Congenital Torticollis
head tilted with chin pointing in opposite direction, results from bleeding into sternocleidomastoid during stretching process of birth, appears as firm fibrous mass within the muscle, disappears over months
65
Pectus excavatum
sternal depression
| M>F (x3)
66
Pectus carinatum
Chicken breast deformity or pigeon chest
| M>F (x4)
67
Findings that may indicate cardiac disease
Poor feeding, failure to thrive, irritability, tachypnea, hepatomegaly, clubbing, poor overall appearance, weakness
68
What is the most common dysthymia?
Paroxysmal supra ventricular tachycardia (PSVT)
69
Hypospadias
Abnormal ventral urethral placement-check for this before circumcision
70
Epispadias
Abnormal dorsal urethral placement-check for this before circumcision
71
What can a sacral dimple indicate?
Spina bifida-need to ultra sound if you can't see the base
72
What can a single palmar crease indicate?
AKA simian crease
| associated with trisomy 21
73
Developmental Dysplasia of the Hips risk factors
Breach, 1st born white female, family history, prematurity
74
Developmental Dysplasia of the Hips evaluation/Treatment
Audible click heard with Barlow or Ortolani
| Treat with Pavlik harness and ortho eval
75
Barlow Test
Test for ability to sublet or dislocate intact but unstable hip-bring bent leg medial
76
Ortolani Test
Tests for posteriorly dislocated hip-pull bent leg laterally
77
Age for Palmar Grasp
birth to 3-4 months
78
Age for plantar grasp reflex
Birth to 6-8 months
79
Moro Reflex (startle reflex)
"drop" baby while holding supine, arms should flail and legs flex
Birth-4 months
80
Moro Reflex abnormalities
Persistence beyond 4-6 months could be neuro disease
| Asymmetric response could be fractured clavicle or brachial plexus injury
81
Asymmetric Tonic Neck Reflex
Baby supine, turn head to one side with jaw over shoulder-arms/legs on that side extend, opposite side flex
Birth-2 months
82
Asymmetric tonic neck reflex abnormalities
Persistence beyond 2 months could be asymmetric central nervous system development
83
Positive Support Reflex
Hold baby and touch feet to surface-hips knees and ankles extend and baby stands
Birth/2 months-6 months
Lack of reflex could be hypotonia or flaccidity
84
Rooting reflex
Stroke personal skin at corners of mouth, mouth will open and baby will turn toward that side
Birth-3/4 months
85
Trunk Incurvation (Galant's reflex)
Hold baby prone and stroke one side of back from shoulder to butt, spine will curve toward that side
Birth-2 months
Absence could be transverse spinal cord lesion/injury
86
Placing and Stepping Reflexes
Hold baby and have one foot touch table, that hip/knee will flex and other will step forward-alternate stepping
Birth-variable age
87
What is the most common cause of childhood blindness
Amblyopia
88
When do we start checking BP
3 year well visit unless other risk factors (kidney disease, premie, CHD, recurrent UTIs, etc)
89
When/why to screen hemoglobin?
for iron deficiency: 9 or 12 months
90
When/why to test for lead?
Ages 1-2, it could cause learning and developmental delays
91
When do we screen for autism?
18 and 24 months
92
Fasting Lipid screening ages/recommendations
Between 2-10years if risk factors present (FH of hyperlipidemia, early CV, obesity, HTN, diabetes)
93
When should first dental visit be?
Between 12 months-3 years
94
How long should baby be rear facing in car seat?
until 2 years, booster until 4'9"
95
1 month Milestones
fix/follow, some head control, responds to noises spontaneous smile
96
2 month Milestones
Responsive smile, coos, lifts head when prone, follows to midline
97
4 month Milestones
Rolls from tummy to back, good head control, laughs, follows past midline, grasps object
98
6 month Milestones
Sits with support, bears weight on legs, reaches for toys, follows 180 degrees, separation anxiety
99
9 month Milestones
Crawls, says mama/dada, pincer grasp, responds to name, pulls up/walks on furniture
100
12 month Milestones
Can start walking, self feeds with fingers, waves, points
101
15 month Milestones
3-6 words, walks well, climbs stairs, imitates
102
18month Milestones
Some 2 word phrases, scribbles, follows simple commands, uses spoon/fork, runs/walk backwards
103
24 month Milestones
20-50 words, kicks ball, build with blocks, 50% speech understandable
104
Vaccines at 2 and 4 months
RV, Tdap, Hib, PCV13, IPV (polio)
105
Hep B Vaccine Schedule
3 doses: at birth, 1-2 months, 6-8 months
106
Hep B Vaccine Contraindications/AEs
Severe yeast allergy
| Can cause fever, injection site pain
107
Rotavirus Vaccine Schedule
Live oral vaccine- 2, 4 and 6 months
108
Rotavirus Vaccine Contraindications/AEs
History of intussusception, infant with SCID, mod-severe gastro
AEs: increased risk of intussusception, vommiting and diarrhea, cough, runny nose
109
Tdap Vaccine Schedule
5 total-2, 4, 6, 15/18 months and 4 years
110
Tdap Vaccine Contraindications/AEs
Encephalopathy, unstable neurological disorders, high fever with previous vaccine
AEs: swelling and redness at sire, fever
111
HIB Vaccine Schedule
4 total- 2, 4, 6, 12/15 months
112
HIB Vaccine Contraindications/AEs
<6 weeks, previous allergic reaction
| AEs: redness or pain at site
113
PCV13 Vaccine Schedule
4 total-2, 4, 6, 12/15 months
114
PCV13 Vaccine Contraindications/AEs
Previous allergic reaction, current illness
| AEs: fever, local reaction, irritability, decreased sleep, possible febrile seizure
115
IPV Vaccine Schedule
4 total-2, 4, 6-18 months and 4 years
116
IPV Vaccine Contraindications/AEs
Previous allergic reaction, current illness, pregnancy
| AEs: local redness/pain
117
MMR Vaccine Schedule
2 at 12-15months and 4 years
118
MMR Vaccine Contraindications/AEs
Pregnant, immunocompromised, egg allergy
| AEs: Fever, transient morbilliform rash, Guillan-barre
119
Varicella Vaccine Schedule
12-15 months and 4 years
120
Varicella Vaccine Contraindications/AEs
Pregnancy, previous allergic reaction
| AEs: injection site reactions/rashes
121
Hepatitis A Vaccine Schedule
12 and 18 months (must be 6 months between)
122
Hep A Vaccine Contraindications/AEs
Pregnancy/illness, previous allergy
| AEs: injection site reaction
123
Crackles/rales
Predominantly on inspiration
Scratchy
Bronchiolitis, pulm edema, pneumonia, asthma
124
Rhonchi
Continuous low pitch
| Pneumonia, cystic fibrosis
125
Viral Croup Etiology/Presentation
Parainfluenza virus
| Inspiratory stridor, hoarseness and barking seal-like cough, "steeple sign" on xray
126
Viral Croup Treatment
Mild: Supportive therapy, cool mist
Moderate: Corticosteroids (dexamethasone 0.6mg/kg IV), nebulized epinephrine
127
Epiglottitis Etiology/Presentation
EMERGENCY
Dysphagia, drooling, distress, tripod posture, sudden onset of high fever, stridor (don't use tongue blade)
H flu
128
Epiglottitis Treatment
```
Airway support (ET tube if possible)
Antibiotics (ceft+vanco)
```
129
Bronchiolitis Etiology/Presentation
RSV
| Patients <2years, premie, lower res symptoms with wheezing and crackles; peaks in Jan/Feb
130
Bronchiolitis Treatment
Symptomatic-O2 if needed, hydration, nutrition, nasal suctioning, mechanical ventilation if necessary
131
Respiratory Syncytial Virus (RSV) Presentation
Congestion with lots of mucus, crackles, prolonged expiration, wheezing, retractions, hyperinflation and peribronchial thickening on xray
Peaks in Jan-feb
132
RSV Treatment
Ribavirin if immunocompromised
Palivizumab for prophylaxis
Otherwise supportive (fluids, resp support)
133
What is the most common cause of respiratory distress in premies?
Respiratory distress syndrome/hyaline membrane disease
134
Respiratory distress syndrome
Deficiency of surfactant production and surfactant inactivation by protein leak into airspaces, causes hypoxia, pulmonary edema
135
Respiratory distress syndrome Risk Factors and Treatment
Prematurity (esp if <28 weeks), maternal diabetes/old age
| Treat with respiratory support, steroids and surfactant replacement
136
Pneumonia Causes by Age
Viral if <5 years (RSV<1 year, parainfluenza 2-5 years)
| Bacterial >5 years (s. pneumoniae)
137
Most common cause of afebrile infant pneumonia?
Chlamydia
138
Atypical Pneumonia causes
Mycoplasma or chlamydia
| More common >5
139
Pneumonia Bacterial vs Viral
Bacterial: consolidation in lobar distribution
Viral: interstitial or peribronchial infiltrates
140
Pneumonia Treatment
Admit if <3-6 months or hypoxemic
| Amoxicillin 90 mg/kg BID x10 days
141
Pertussis Etiology/Presentation
Bordetella Pertussis
3 phases: phase 1-catarrhal URI symptoms and fever for 1-2 weeks
Phase 2: paroxysmal (2-6 weeks) whooping cough, post-tutsis emesis
Phase 3: Convalescent (weeks-months) gradually resolving cough
142
Pertussis Treatment
Want to treat in Phase one (catarrhal)
| Macrolides or TMP-SMX, prophylaxis for household
143
Pertussis Gold Standard Diagnostic
PCR and culture of nasal secretions
144
Cystic Fibrosis Etiology/Presentation
Most commonly H flu or staph aureus early, pseudomonas later in life
High salt content in sweat glands (hallmark), recurrent sinus/ear infections, nasalpolyps
145
What is the most common life-threatening genetic disease in whites?
Cystic fibrosis
146
Cystic Fibrosis Treatment
airway clearance (respiratory failure is most common cause of death), managed by specialist
147
Special treatments in CF
Treat respiratory infections/cough early, they're succesptible to infection
Salty snacks and lots of water to prevent hyponatremic dehydration
148
What neuro diseases are static?
Congenital abnormalities or brain injury (cerebral palsy)
149
Which neuro diseases are progressive?
degenerative disease or neoplasms
150
Which neuro diseases are intermittent?
Epilepsy or migraine syndromes
151
Saltatory neuro diseases
Bursts of symptoms followed by partial recovery
| Vascular or demyelinating disorders
152
Indications of spina bifida
tufts of hair, lipomas, dimpling
153
What can accelerating/decelerating head growth patterns indicate?
Accelerating: hydrocephalus
decelerating: degenerative neurologic disorder
154
What does abnormal head shape indicate?
Craniosynostosis (premature suture closure
155
When do the posterior and anterior-lateral fontanelles close?
post: 2 months
| ant-lat: 3 months
156
Signs of lower motor neuron lesions
Flaccid paralysis, absent reflexes (lowers everything), weakness
Fasciculations present
157
Signs of upper motor neuron lesions
Spastic paralysis, increased reflexes (increases everything), stiffness
NO fasciculations
158
What is the most common cause of headaches in kids?
Strep (URI)
159
Life threatening causes of headache
meningitis, encephalitis, cerebral abscess, subarachnoid hemorrhage, increased ICP
160
What is the most concerning headache pattern?
chronic progressive (usually increased ICP- pseudotumor cerebri, brain tumor, hydrocephalus, etc)
161
Pediatric Migraine symptoms
pounding/throbbing for 2-72 hours, received by sleep, N/V, phono/photophobia, abdominal pain
162
Migraine Management in kids
NSAIDs, acetaminophen, triptans, antiemetics
163
Migraine prophylaxis
Under 6: cryproheptadine
| Over 6: propranolol, amitriptyline, topiramate
164
Pseudotumor cerebri
idiopathic intracranial hypertension, increased ICP without space occupying lesion or obstruction, usually in 11+year olds
165
Presentation of Pseudotumor Cerebri
headache, blurred vision, diplopia, vision loss, papilledema
166
Diagnosis of pesudotumor cerebri
Must rule out all other causes of ICP, imaging before lumbar puncture
167
Treatment of pseudotumor cerebri
Acetazolamide, topiramate, optic nerve sheath fenestration, CSF shunt, decreased salt intake
168
Cerebral Palsy
Non-progressive motor and postural dysfunction resulting from brain injury or malformation
169
4 classifications of Cerebral Palsy
Spastic (most common, UMN lesions), athetoid/dyskinetic, ataxic (most rare), atonic
170
Treatment goals of cerebral palsy
social/emotional development, communication, education, nutrition, mobility, max independence
171
Spina bifida
neural tube disorder associated with folic acid
| defective closure of caudal neural tube in gestation
172
Most common type of spina bifida
Spina bifida occults-skin intact but defects in bone and spinal canal, may have sinus tract, dimple or tuft of hair
173
Prevention and treatment of spina bifida
Prevent with folic acid supplementation
| Treat with surgical closure, VP shunt, supportive therapy
174
Chiari Malformation
Anomaly of cerebellum, brainstem and craniocervical junction with downward displacement of cerebellum alone or with lower medulla into spinal canal
175
Chiari 2 Malformation
Most common- syringiomyelia, myelomeningocele, herniation of cerebellar tonsils
176
Hydrocephalus Presentation
Looking down, headache, vomiting, altered mental status, visual changes, increased head circumference, bulging anterior fontanelle, abnormal skull contour, papilledema
177
Treatment of Hydrocephalus
symptomatic (diuretic, acetazolamide), surgery (remove obstruction, VP shunt)
178
Spinal muscular atrophy Diagnosis
Homozygous deletion of exon 7 of SN1
179
Spinal muscular atrophy
Progressive weakness of lower motor neuron with progressive proximal weakness, decreased spontaneous movement and floppiness (loss of head control and leg movement, decreased facial expression/drooling, but normal mental social and language skills and preserved sensation)
180
Diagnosis of spinal muscular atrophy
DNA testing (homozygous deletion of exon 7 of SN1), EMG, muscle biopsy
181
Treatment of spinal muscular atrophy
symptomatic to improve flexibility, prevent infection, maintain social, language and intellectual stimulation
182
Guillain Barre Syndrome Causes
Respiratory or GI infection (campylobacter jejunii)
183
Guillain Barre Presentation
Ascending weakness, refusal to walk/leg pain in kids, loss of reflexes
184
Treatment of Guillain Barre
IVIG, plasmapheresis
| May have residual parasthesia, fatigue and limb weakness
185
Duchenne Muscular Dystrophy Presentation
X-linked-boys only with awkward gait, gowers sign
| Starts in proximal extremities moves distal (in lower then upper)
186
Duchenne Muscular Dystrophy Diagnosis
Muscle biopsy, EMG, serum CK levels (10-20x upper limit), genetic testing
187
Duchenne Muscular Dystrophy Treatment
Glucocorticoids, pulmonary and cardiac follow up
188
Neurofibromatosis
Genetic disorder where nerve tissue grows tumors that cause nerve/brain damage
189
2 types of Neurofibromatosis
Type 1 more common-autosomal dominant (chromosome 17), more peripheral, skin and brain
Type 2 autosomal dominant (chromosome 22), more severe, sinal cord abnormalities, central type
190
Neurofibromatosis Type 1 Presentation
Cafe-au-lait spots, Neurofibromas, CNS tumors
191
Neurofibromatosis Type 1 Treatment
Surgical removal of tumors, genetic counseling/screening
192
Neurofibromatosis Type 2 Presentation
Bilateral vestibular schwannomas, no cafe-au-lait spots
193
Whats the most common neurologic disorder infants and young kids?
Febrile seizure
194
Febrile Seizure Presentation
Younger then 5years, generalized seizure <15 minutes, high fever (>104)
195
2most common viruses in febrile seizure
HHV-6 and influenza
196
Treatment of febrile seizure
IV benzos, if no IV access then buccal midazolam
197
Common pathogens in bacterial conjunctivitis
S pneumoniae, H flu
| in newborns: chlamydia
198
Pathogens causing viral conjunctivitis
Adenovirus
199
Most common pathogen of Periorbital cellulitis
S aureus and S pyogenes
200
Periorbital symptoms and Treatment
redness and swelling, pain, mild fever; NORMAL vision and EOMs
oral/systemic antibiotics (augmentin)
201
Orbital Cellulitis Pathogen, Symptoms and Treatment
Staph/strep (s aureus)
Pain w/ EOMs, proptosis, decreased vision
Treat with IV antibiotics and emergent ophtho consult
202
Kawasaki Disease
Widespread inflammation of arteries including coronaries-leading cause of acquired heart disease in kids in US
203
Presentation of Kawasaki Disease
Fever longer than 5 days, bilateral conjunctivitis, cracked lips, strawberry tongue, perineal rash that spreads, lymphadenopathy
204
Treatment of Kawasaki Disease
IVIG and aspirin (the only time we'll use aspirin in babies!)
205
Complications of Kawasaki Disease
Coronary artery aneurysms (MI, stroke, sudden death)
206
Dacryostenosis
Nasolacrimal duct obstruction, causes persistent tearing and discharge
207
Dacryocystitis
Infection of dacryostenosis (Staphs/streps), treated with IV antibiotics if severe
208
Strabismus
Misalignment of the eyes, can cause or be due to amblyopia
209
Treatment of acute otitis media
Younger than 2-amoxicillin 90mg/kg BID
| Over 2, observe unless high fever, bilateral or >48 hours
210
Treatment of otitis media with tubes
Fluoroquinolone (Cipro) drops +/- corticosteroid
211
Otitis Externa Treatment
```
Antibiotic drops (ciprodex)
if perforated use FQ suspension
```
212
Allergic Rhinitis Presentation
Allergic shiners/salute, blue/boggy mucosa, cobblestoning of pharynx, clear rhinorrhea
213
Allergic Rhinitis Treatment
Intranasal steroids (Flonase >4, nasacort >2), antihistamines (if older than 6 months)-diphenhydramine
214
Sinusitis Presentation
10-14 days of URI symptoms without improvement, purulent nasal discharge, dental pain
215
Sinusitis Pathogen/Treatment
H flu, (S pneumoniae if bacterial)
| Augmentin/amoxicillin 90mg/kg BID if bacterial, if viral then symptomatic
216
Pharyngitis Causes
Viral is most common (adenovirus, rhino, coxsackie)
| Bacterial: group A strep
217
Viral Pharyngitis Presentation/Treatment
Red throat, fever, congestion, fatigue, swollen cervical nodes
Treat with analgesics, fluids, rest (symptomatic)
218
Epstein Barr Virus (mono) Presentation
Exudative tonsillitis, cervical lymphadenopathy, splenomegaly
219
Epstein Barr Treatment
Spleen precautions (no sports6-8 weeks), fluids, airway support, analgesics, steroids
220
Bacterial Pharyngitis Presentation
Abrupt onset, headache, nausea, rash, sore throat, palatal petechiae, exudative tonsillitis
if <3-nasal congestion, low fever, an cervical lymphadenopathy
221
Bacterial Pharyngitis Diagnosis/Treatment
Gold standard is throat culture, otherwise rapid antigen
| Treat with Penicillin>amoxicillin, if allergic then ceft or clindamycin
222
Acute Rheumatic Fever Presentation
2-3 weeks post strep- Major: migrating poly arthritis, carditis/valvulitis, chorea, erythema marginatum, subQ nodules
Minor: arthralgia, fever, elevated CRP/ESR, prolonged PR interval
2 major+1 minor
223
#1 cause of acquired valve disease
rheumatic heart disease
224
Diagnosis and Treatment of Acute rheumatic fever
ASO titers with neg strep antigen
| Amoxicillin, aspirin, evaluate for carditis
225
Post-streptococcal glomerulonephritis Presentation
Edema, hematuria (tea colored urine), proteinuria, hypertension
ASO titer positive
226
Post-strep glomerulonephritis Treatment
Self limited, can use diuretics for prolonged htn and edema
227
Peritonsilar Abscess Cause/Presentation
S. pyogenes
| Hot potato voice, truisms (neck pain/stiffness), deviated uvula, resp distress, drooling, pain with swallowing
228
Treatment of Peritonsillar abscess
Airway management, surgical I and D, antibiotics
229
Coxsackie Virus Presentation
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Hand, foot and mouth
oral lesions (herpangina), vesicular rash on hands and feet, low fever, sore throat
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230
Coxsackie Virus Treatment
supportive
231
Herpetic Gingivostomatitis Presentation/Treatment
fever, sleeplessness, headache, ulcerated lesion that bleed
| Treat with acyclovir, hydration, NSAIDs
232
Measles Presentation
Conjunctivitis, coryza, cough, kopek spots, maculopapular blanching rash starting on face
233
Measles Diagnosis and Treatment
IgM assay
| Supportive treatment, report to health department, prevent spread
234
Mumps Presentation/Treatment
Parotitis (tender, swelling, earache), orchitis/oophoritis w/ fever, pain and swelling
Supportive treatment, prevent spread
235
Rubella Presentation/Treatment
Fever with post auricular and occipital adenopathy, rash starts on face, disappears in 3 days
Can cause purpuric "blueberry muffin" rash at birth
Supportive treatment
236
Diaper Candidiasis Presentation/Treatment
"Beefy red" erythema with satellite lesions, involves skin folds
Treat with clotrimazole or nystatin-NO STEROIDS!
237
Cradle Cap
Greasy, yellow scales on scalp-basically baby dandruff
| Treat with emollient, remove scales with soft baby brush or toothbrush, topical steroid or ketoconazole if severe
238
Impetigo Cause/Treatment
Honey colored crusts, usually on face/extremities
S aureus or strep
Treat with mupirocin (bactroban)
239
Innocent Murmurs
Still's murmur, venous hum murmur, peripheral pulmonary stenosis
240
What is the most common innocent murmur
Still's murmur
241
Still's Murmur
Normal EKG
Low frequency, musical, vibratory sound, loudest in supine and stress, changes intensity with sitting
Outgrow with age
242
Venous Hum Murmur
Continuous (R/diastolic>L/systolic), heard at the base, loudest when upright, decreased supine or turning neck
243
What is the most common congenital abnormality causing morbidity/mortality in 1st year?
CHD (congenital heart defect)
244
Acrocyanosis
Benign variant of peripheral cyanosis with normal pulse, goes away within hours
245
Patent Ductus Arteriosus
Stays open for a few hours to mix blood, closes functionally at 12-90 hours, closes anatomically at 2-3 weeks
246
Blue Baby
Right to left shunt/obstruction to lungs
PDA is closing early due to CHD
Cyanotic, low oxygen saturations/pulmonary blood flow
247
Grey Baby
No mixing of blood-poor perfusion (no pulse or cap refill), PDA is closed (needs prostaglandins to open it), lactic acidosis
248
Purple Baby
PDA potency open
249
Types of Congenital Heart Defects
Acyanotic (volume issue)
Cyanotic
Obstructive
Complex heart/single ventricle
250
Acyanotic Heart Defects
Left to right shunt, volume overload
ASD: R ventricular overload
VSD, PDA, AV: L ventricular overload
No prostaglandins!
251
Symptoms of left to right shunts
Tachypnea, poor feeding/failure to thrive, exercise intolerance, poor growth
Large ASDs asymptomatic
252
Atrial Septal Defect Exam Findings
Fairly common
Precordial bulge
Fixed split of S2 with grade 2-3 systolic ejection murmur at LUSB with diastolic rumble at RLSB
EKG might show right axis deviation and right ventricular conduction delay
253
Atrial septal defect treatment
Observation, usually closes in first few years
| Surgery if needed
254
What is the most common congenital heart defect?
Ventricular septal defect
255
Ventricular Septal Defect
Can cause CHF
Small defect: holosystolic murmur
Large defect: diastolic murmur of aortic regurge with apical diastolic rumble
EKG may have RVH and LVH, xray may show cardiomegaly
256
CHF Symptoms
Diaphoresis with feeding, failure to thrive, hepatomegaly
257
Patent Ductus Arteriosus Presentation
Most commonly newborns
Continuous machinery-like murmur at LUSB/axilla with diastolic rumble, bounding pulses with wide pulse pressure, CHF, diaphoresis with feeding
Major cause of cyanosis with lower extremity saturations lower than uppers-pulse-ox screening in US in RUE and LLE
258
Patent Ductus Arteriosus Treatment
Younger child: NSAIDs and prostaglandins
| In older child: coil/device occlusion and ductal ligation
259
Cyanotic Heart Defects
Tetralogy of fallot
Transposition of great arteries
Trunctus arteriosus
Require prostaglandins to treat!
260
Tetralogy of Fallot
Most common cyanotic defect
| Comprised of 4 abnormalities: VSD, PS/RVOT obstruction, overriding aorta, RVH
261
Tetralogy of Fallot Presentation
Harsh systolic LUSB
Cyanosis
Boot shape on chest xray
262
TET Spell
Cyanotic spell of baby with Tetralogy of Fallot-spasm of RVOT infundibular muscle; loss of murmur, cyanotic
Keep baby calm, give oxygen
263
Transposition of the Great Arteries (TGA)
State of parallel circulation-oxygenated blood recirculated through lungs>hypoxemia and acidosis-imminent death unless theres a PFO, VSD or PDA
264
TGA Treatment
Arterial switch operation
265
Truncus Arteriosus
Heart failure symptoms in first few weeks of life, diagnosed with echo, treated with surgery
266
Obstructive Heart Defects
Obstruction to pulmonary blood flow (pulmonary stenosis), and systemic blood flow (coarctation of aorta, aortic stenosis)
All cyanotic and need prostaglandins to treat
267
Pulmonary Stenosis Presentation
Harsh systolic ejection murmur at LUSB with click
EKG shows RVH
Treated with balloon valvuloplasty
268
Coarctation of Aorta
Narrowing of aortic isthmus
Systolic murmur at precordium, decreased lower extremity pulses, blood pressures off by 20mmHg
Associated with Turner Syndrome
Treated with prostaglandins
269
Aortic Stenosis
Systolic ejection murmur at RUSB with a click
EKG and echo shows LVH
Treated with prostaglandins, sx, balloon valvuloplasty
270
Hypoplastic Left Heart Syndrome
Complete mixing of blood in atria with obstruction of pulmonary or systemic blood flow
Treated with 3 stages
271
12 categories of Cardiac screening
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1-Exertional chest pain/discomfort
2-unexplained syncope
3-excessive dyspnea/fatigue
4- prior heart murmur
5-^systemic BP
6- fam hx of early death
7-fam hx of disability from heart disease
8- fam hx of cardiac conditions
9- heart murmur on exam
10- check femoral pulses
11- check for marfans
12- brachial BP
```
272
What are the highest risk sports?
Basketball, track, football
273
What does Europe include in cardiac screening that US does not?
EKG! (echo isn't recommended either)
274
Hypertrophic Cardiomyopathy
Autosomal dominant
Abnormal stiffness of LV with impaired diastolic filling, preserved systolic functioning
Restrict from sports
EKG shows LVH and inverted t waves
275
Marfan's Syndrome Complications
Aortic root dilation or rupture, mitral valve prolapse
276
Commotio Cordis
Blunt force trauma to chest in from of heart
277
Pediatric Dyslipidemia
Screen between 9-11, can start statins as young as 10
