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Flashcards in peds23 Deck (100):
1

management for NLD obstruction

observation for most kids (half resolve), nasolacrimal massage, topical antibiotics if infected; NLD probing through hasner's valve into nose

2

amniotocele (dacryocele)

swelling of the nasolacrimal sac

3

cause of amniotocele

accum of fluid due to NLD obstruction

4

clinical features of amniotocele

blusih swelling in the medial canthal area may be apparent and represents fluid sequestered withn the nasolacrimal sac; infection may occur

5

management of amniotocele

local massage if no evidence of infection; IV antibiotics and urgent NLD probing if infections

6

retinal hemorrhages

highly suggestive of child abuse! Nonabuse causes include birth trauma, leukemia, incr ICP, malignant htn, bacterial endocarditis, immune thrombocytopenia purpura, and, rarely, cardiopulm resuscitation

7

clincal features of retinal hemorrhage

hemorrhagic dots and blots, or hemorrhage within the preretinal vitreous on a dilated fundoscopic exam

8

corneal abrasion

cause is traum, incl injury from contact lens; pain, tearing, and photophobia. Also foreign body sensation

9

diagnosis of corneal abrasion

identification on fluorescein staining of the cornea

10

management of corneal abrasion

ealing usually in 24-48 hours; placement of patch for that time is recommended in severe cases; topical antibiotic to prevent bacterial superinfection; optho consult if abrasion associated with contact lense

11

hyphema

blood within the anterior chamber

12

causes of hyphema

blunt trauma is most frequent cause; other causes are iris neovascularization and iris tumors

13

iris tumor

juvenile xanthogranuloma

14

clinical features of hyphema

impaired vision, blood-aquoeous fluid level

15

complications of hyphema

rebleeding 3-5 days after initial injury; glaucoma; staining of the cornea with blood; optic nerve damage in kids with sickle cell disease

16

management of hyphema

optho consult and bed rest for at least 5 days

17

orbital floor fracture due to what?

blunt trauma

18

clinical features of orbital floor fracture

orbital fat and inferior rectus muscl can become trapped in the fracture and lead to diplopia due to restricted vertical eye movement, to strabismus, and to enophthalmos

19

enophthalmos

backward displacement of the eye

20

why would numbness of the cheek and upper teeth below the orbital fracture occur?

infraorbital nerve injury

21

management of orbital floor fracture

empiral oral antibiotics to prevent max sinus organisms from getting to the orbit; also surgical repair if diplopia persists 2-4 wks after injury or if enophthalmos is signif

22

congenital glaucoma

incr intraocular pressure occuring at or soon after birth

23

adult glaucoma

pressure damages the optic nerve but does not change the size of the eye

24

congenital glaucoma

not only results in optic nerve injury but also expands the size of the eye; results in corneal edema, corneal clouding, and amblyopia

25

cause of congenital glaucoma

outflow of acqueous humor is reduced bc of maldevelopment of the trabecular meshwork (aut dom); other causes are infection or genetic syndromes

26

clinical features of glaucoma

tearing, photophobia, enlarged cornea, corneal clouding, and dull red reflex

27

glaucoma is often misdiagnosed as what?

NLD obstruction

28

bilateral glaucoma?

seen bilaterally in congenital glaucoma in 70% of patients

29

management of glaucoma

surgery to open outflow channels is almos always required; topical or systemic b-ags and carbonic anhydrase inhib, may help lower pressure

30

prognosis for congenital glaucoma

if not detected and surgically treated early, leads to blindness

31

retinopathy of prematurity

proliferation of vessels in premature infants exposed to oxygen

32

late complications of ROP

myopia, astigatism, amblyopia, strabismus, and blindness

33

management of ROP

optho exams every 1-2 weeks to monitor prgoress; if disease is severe, retinal cryotherapy and laser therapy may be effective

34

two most impt ways to prevent ROP

limit oxygen delivered and effective treatment of hyaline membrane disease

35

who should get a dilated optho exam at 4-6 weeks of age

infants born at less than 28 weeks or less than 1500 g

36

leukocoria

white pupil; refers to opacity at or behind the pupil; can be caused by cataract, opacity within the vitreous, or retinal disease like retinoblastoma

37

congenital cataract

crystalline opacity of the lens present at birth

38

most common cause of cataract?

idiopathic

39

genetic syndromes that can cause cataracts

down, noonan, marfan, alport, and smith-lemli-opitz syndrome

40

what metabolic derangements can cause cataracts

hypoglycemia, galactosemia, and DM

41

what intrauterine infections can cuase cataracts?

CMV and rubella

42

can trauma cause cataracts?

yes

43

management of cataracts

early surgery to prevent amblyopia

44

prognosis for congenital cataract

treated within the first few weeks of life- good prognosis; but surery performed later is associated with poor visual outcome

45

most common ocular malignancy in childhood

retinoblastoma

46

average age of presentation of retinoblastoma

13-18 months. More than 90% of cases dx before 5 years of age

47

genetics of retnoblastoma

mutation or deletion of growth supp gene on both alleles on the long arm of chrom 13; two hit model

48

two most common presenting signs of retinoblastoma

leukocoria and strabismus

49

hallmark of retinoblastoma?

calcification within the tumor identified on imaging studes of the eye

50

management of retinoblastoma

large tumors involving the macula are treated by removing the eye; smaller tumors may be treated with external beam radiation (which may induce secondary tumors); very small peripheral tumors can be treated with cryotherapy or laser photocoagulation

51

starbismus

misalignment of the eyes

52

esotropia

eye turned nasally

53

exotropia

eye turned laterally

54

vertical strabismus

eye turned up or down

55

pseudostabismus

prominence of the epicanthal folds that results the false appearance of stabismus

56

if strabismus occurs before age 6

child suppresses the image in the deviated eye and amblyopia may result

57

if strabismus occurs after age 6

the mature visual system can't suppress the image and diplopia develops

58

management

ocular patching to prevent amblyopia; corrective lenses if farsighted; surgery if misalignment does not respond to patch or glasses

59

when is fifth disease no longer contagious?

when facial rash appears

60

management of fifth disease

supportive. IV IG can be used to treat chronic anemia in immunosupp patients

61

roseola infantum

aka exanthem subitum

62

roseloa most common in what agr

under 2

63

what causes roseola?

HHV 6 and 7; other causes ar adenovirus, parvi, b19, and echovirus 16

64

clinical features of roseola

begins with 3-5 days of high fever; once the fever resolves, a pink papular eruption occurs in the trunk and fades in 24-48 hrs

65

management of roseola infantum

supportive

66

gianotti-crosti syndrome

papular acrodermatitis; associated with hep B infection, EBV, CMV, and coxsackievirus

67

clinical features of gianotti-crosti syndrome

red or flescolored papules in acral areas; URI symptoms may precede the eruption; treatment is supportive

68

clinical features of varicella

intensely pruriti erythematous macules develop after a 7 to 21 day incubation period; looks like a dew drop on a rose petal (vesicle on a red background)

69

management of varicella

antipyretics, cleansing with antibacterial soaps; antihistamines for itching; acyclovir for varicella pneumonia and encephalitisi or in eyes for eye involvement

70

most common HSV infection during infancy

gingiostomatitis, almost always caused by hsv 1

71

characteristic lesions for hsv

grouped vesicles on an erythematous base

72

hsv gingivostamatitis

young infants with grouped vesicles and ulcers on the lips, mouth, tongue

73

neonatal hsv

first week of life; may have just a few vesicles; serious sequelae include meningoencephalitis, hepatitis, sepsis, shock and death; hsv2 more common than hsv1

74

herpetic whitlow

hsv-1 infection; of the thumb or fingers (usually 2/2 thumb sucking by kid with oral hsv lesion)

75

where does hsv reside?

dorsal root ganglion; can reactivate

76

recurrent hsv lesions?

more mild and less symptomatic; generally occur on lip

77

how to diagnose hsv?

tzanck preparation, by detection of hsv antigen on fluorescent antibody testing, or culture of base of lesion; pcr of cerebrospinal fluid

78

management of hsv

neonatal hsv is medical emergency! Iv acyclovir; cutaneous and oral hsv may be treated with oral acyclovir promptly

79

hand-foot-mouth disease

coxsackievirus

80

clinical features of hand-foot-mouth diseae

vesicles, papules, or pustules on the palms, soles, fingers, and shallow ulcer on the soft palate or tongue

81

if only oral lesions are present in hand-foot-mouth disease, what do you call it?

herpangina

82

management of herpangina or hand foot mouth

supportive

83

what causes warts?

hpv

84

condylomata acuminata

term to describe multiple external warts in the genital area

85

management of warts

resolve spontaneously in 1-2 years; can treat but recurrance after treatment is high

86

molloscum cantagiosum is caused by what?

pox virus

87

molloscum features

flesh-olored papules with central umbilication

88

what disease is associated with eruption of molluscum

hiv infection

89

management of molluscum

just watchful waiting; can remove like wart

90

louse infestation

pediculus humanus (head and body lice) and phthirus pubis (pubic lice)

91

louse associated with what?

crowded living conditions, sharing hats, clothes, combs

92

body lice

papules and pustules on the trunk with excoriations

93

pubic lice

lice or nits in the groin and blackcrusted papules or blue macules (macula cerulea)

94

management of head lice

permethrin shampoo and comb

95

management of body and pubic lice

12 hours application of hexachloride lotion

96

scabies caused by what?

mite named sarcoptes scabei

97

clinical features of scabies

pruritic papules or vesicles all over body; severe itchign and S shaped burrows

98

management of scabies

overnight applic of permethrin lotion or lindane (adults only); highly contagious so treat all household contacts; wash all sheet and clothes

99

causes of hypopigmentation

postinflamm; pityriasis alba; vitiligo; oculocutaneous albinism

100

postinflamm hypopigmentation caused by what and resolves in how long?

may follow any skin inflamm (like atopic dermatitis) and resolves in months to years