11 Flashcards
conjunctiva appears red and swollen, with some mild lid edema +/- drainage
conjunctivitis
Causes of conjunctivitis
Allergies
Chemical irritation, or
Infection
ddx for periorbital swelling, fatigue and poor appetite
hepatic failure, CHF, nephrotic syndromic, glomerular nephritis
Why abdominal distension glomerulonephritis, nephrotic syndrome, and hepatic failure?
hypoalbuminema
First sign of hypoalbuminemia in nephrotic syndrome?
periorbital edema
How is HTN defined in a child?
systolic or diastolic blood pressure at or above the 95th percentile measured on three or more occasions,
What cardiac finding supports high fluid volume?
S4 gallop, if present, would indicate an overloaded left ventricle, and would suggest congestive heart failure
A little boy comes in with periorbital edema. What all can you do to assess fluid status?
Lungs - dullness or crackles Cardiac - S4 Abdomen - fluid wave Extremities - pitting edema GU - scrotal edema
ascites, edema, hypertension and hematuria
acute glomerulonephritis
ascites, edema, tachycardia, murmur, a gallop, hepatomegaly.
CHF
ascites, edema, jaundice
hepatic failure
four criteria for nephrotic syndrome
nephrotic range proteinuria, hypoalbuminemia, edema, and hyperlipidemia.
How does edema occur in nephrotic syndrome
Decreased serum oncotic pressure from hypoalbuminemia results in interstitial fluid accumulation and resultant edema (the excess fluid is in the interstitial space, and not necessarily in the vascular space; patients may actually be hypovolemic. This is why patients with nephrotic syndrome do not necessarily become hypertensive
Why hyperlipidemia in nephrotic syndrome?
Body is attempting to increase oncotic pressure through biosynthesis
Primary cause of nephrotic syndrome?
Minimal change disease
Child comes in with gross hematuria (usually tea or cola colored), hypertension, edema. What recent history should you ask about?
Patient likely has PSGN. Recent pharyngitis or skin infection with strep pyogenes
golden honey-colored crust, under nose and around wounds/insect bites,
Impetigo - either strep pyogenes or staph
You suspect PSGN in child with swelling. What labs to check?
ASO titers (elevated)
Streptozyme test (positive)
Anti-DNAase B antibodies (elevated)
C3 (low)
What is a nephrotic range protein:creatinine?
> 2
How to treat children with nephrotic syndrome
corticosteroids, salt restriction (1500-2000mg) +/- furosemide and albumin (save for children with symptomatic fluid overload)
Why not give albumin alone to child with nephrotic syndrome?
Quick volume redistribution into vessels, which could lead to CHF and pulmonary edema
Common infectious complications of nephrotic syndrome
Spontaneous bacterial peritonitis
Pneumonia
Cellulitis
UTI
What health preventative measures should a child in nephrotic syndrome remission take?
Polyvalent pneumococcal vaccine
Two doses of varicella vaccine (if not already immunized)
An annual influenza vaccine
Name secondary lesions (occur later in the course of a lesion or rash)
Scale, crust, fissure, erosion, ulcer, excoriation
atopic triad
asthma, eczema, and allergies
What virus causes Roseola rash?
human herpes virus-6 (HHV-6)
pruritic, erythematous, scaling plaques on extensor surfaces
exzema
colonization by Malassezia species
seborrheic dermatitis
papules in the beard area
pseudofolliculitis
red, tender, nodular lesions on pretibial surface of the legs
erythema nodosum
occlusion of pilosebacious gland, super-infected with Propioniobacterium acnes.
acne vulgaris
occlusion of the apocrine follicular units, super-infected by s. aureus or s. pyogenes
hidradenitis supportiva
can early rosacea present with inflammatory papules and micropustules
YES
What is a good starting point for treatment of mild comedonal acne?
OTC benzoyl peroxide (BPO), or Retinoids
Moderate acne treatment
BPO, retinoids + topical or oral antibiotic
Whats a good topical abx for acne?
clindamycin or erythromycin (antibiotics active against P. acnes)
Good oral pill for acne?
doxycycline or tetracycline
When to use oral isotretinoin for acne
When severe and all other has failed
You prescribe a doxycycline for a boy with moderate acne. What SE to look out for?
photosensitivity, esophagitis, dental staining in children under age 9, teratogenicity, and pseudotumor cerebri
How does Isotretinoin combat acne?
Reduces sebum production, P. acnes proliferation, and follicular hyperkeratosis, and has anti-inflammatory effects
What is chronic nickel contact dermatitis an example of?
delayed type IV hypersensitivity reaction
What is a dimethylglyoxime test
Tests for presence of nickle, helpful for those with an allergy to safe proof home
crusty honey colored lesion under nares. what is it and how to treat
Impetigo (s. pyogenes or s. aureus), mupirocin
MILD topical steroid
hydrocortisone acetate, 1% (OTC)
Intermediate topical steroid
triamcinolone acetonide, 0.1%
Potent topical steroid
betamethasonedipropionate, 0.05%
Class 1/super potent topical steroid
clobetasol propionate, 0.05%
How much more potent is clobetasol compared to OTC hydrocortisone?
1000 x more potent
SE of topical steroid use
Skin atrophy
Telangiectasias
Hypopigmentation
Suppression of the hypothalamic-pituitary axis
Is ringworm acutally caused by a worm?
NO, fungus
You suspect a child has ringworm based on clinical exam, but you want to confirm the diagnosis. How to do it?
KOH wet-mount examination of skin scrapings
Tinea versicolor
malassezia species - pink, brown, or white lesions, Excess heat and humidity predispose to the infection.
First-line treatment is selenium sulfide lotion.
Treatment for tinea capitus?
Oral griseofulvin
3 causes of diaper rash
Irritant dermatitis
Diaper candidiasis
Bacterial infection, especially caused by perianal Group A streptococcus
skin folds, satellite lesions, bright red
diaper candidiasis
Which antifungal is approved for use in children?
nystatin (AVOID the azoles)
rare systemic causes of diaper rash
zinc deficiency, and Langerhans Cell Histiocytosis.
