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Pediatrics AQ cases > 11 > Flashcards

11 Flashcards

1
Q

conjunctiva appears red and swollen, with some mild lid edema +/- drainage

A

conjunctivitis

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2
Q

Causes of conjunctivitis

A

Allergies
Chemical irritation, or
Infection

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3
Q

ddx for periorbital swelling, fatigue and poor appetite

A

hepatic failure, CHF, nephrotic syndromic, glomerular nephritis

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4
Q

Why abdominal distension glomerulonephritis, nephrotic syndrome, and hepatic failure?

A

hypoalbuminema

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5
Q

First sign of hypoalbuminemia in nephrotic syndrome?

A

periorbital edema

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6
Q

How is HTN defined in a child?

A

systolic or diastolic blood pressure at or above the 95th percentile measured on three or more occasions,

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7
Q

What cardiac finding supports high fluid volume?

A

S4 gallop, if present, would indicate an overloaded left ventricle, and would suggest congestive heart failure

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8
Q

A little boy comes in with periorbital edema. What all can you do to assess fluid status?

A 
Lungs - dullness or crackles 
Cardiac - S4
Abdomen - fluid wave
Extremities - pitting edema
GU - scrotal edema
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9
Q

ascites, edema, hypertension and hematuria

A

acute glomerulonephritis

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10
Q

ascites, edema, tachycardia, murmur, a gallop, hepatomegaly.

A

CHF

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11
Q

ascites, edema, jaundice

A

hepatic failure

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12
Q

four criteria for nephrotic syndrome

A

nephrotic range proteinuria, hypoalbuminemia, edema, and hyperlipidemia.

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13
Q

How does edema occur in nephrotic syndrome

A

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

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14
Q

Why hyperlipidemia in nephrotic syndrome?

A

Body is attempting to increase oncotic pressure through biosynthesis

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15
Q

Primary cause of nephrotic syndrome?

A

Minimal change disease

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16
Q

Child comes in with gross hematuria (usually tea or cola colored), hypertension, edema. What recent history should you ask about?

A

Patient likely has PSGN. Recent pharyngitis or skin infection with strep pyogenes

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17
Q

golden honey-colored crust, under nose and around wounds/insect bites,

A

Impetigo - either strep pyogenes or staph

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18
Q

You suspect PSGN in child with swelling. What labs to check?

A

ASO titers (elevated)
Streptozyme test (positive)
Anti-DNAase B antibodies (elevated)
C3 (low)

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19
Q

What is a nephrotic range protein:creatinine?

A

> 2

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20
Q

How to treat children with nephrotic syndrome

A

corticosteroids, salt restriction (1500-2000mg) +/- furosemide and albumin (save for children with symptomatic fluid overload)

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21
Q

Why not give albumin alone to child with nephrotic syndrome?

A

Quick volume redistribution into vessels, which could lead to CHF and pulmonary edema

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22
Q

Common infectious complications of nephrotic syndrome

A

Spontaneous bacterial peritonitis
Pneumonia
Cellulitis
UTI

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23
Q

What health preventative measures should a child in nephrotic syndrome remission take?

A

Polyvalent pneumococcal vaccine
Two doses of varicella vaccine (if not already immunized)
An annual influenza vaccine

24
Q

Name secondary lesions (occur later in the course of a lesion or rash)

A

Scale, crust, fissure, erosion, ulcer, excoriation

25
Q

atopic triad

A

asthma, eczema, and allergies

26
Q

What virus causes Roseola rash?

A

human herpes virus-6 (HHV-6)

27
Q

pruritic, erythematous, scaling plaques on extensor surfaces

A

exzema

28
Q

colonization by Malassezia species

A

seborrheic dermatitis

29
Q

papules in the beard area

A

pseudofolliculitis

30
Q

red, tender, nodular lesions on pretibial surface of the legs

A

erythema nodosum

31
Q

occlusion of pilosebacious gland, super-infected with Propioniobacterium acnes.

A

acne vulgaris

32
Q

occlusion of the apocrine follicular units, super-infected by s. aureus or s. pyogenes

A

hidradenitis supportiva

33
Q

can early rosacea present with inflammatory papules and micropustules

A

YES

34
Q

What is a good starting point for treatment of mild comedonal acne?

A

OTC benzoyl peroxide (BPO), or Retinoids

35
Q

Moderate acne treatment

A

BPO, retinoids + topical or oral antibiotic

36
Q

Whats a good topical abx for acne?

A

clindamycin or erythromycin (antibiotics active against P. acnes)

37
Q

Good oral pill for acne?

A

doxycycline or tetracycline

38
Q

When to use oral isotretinoin for acne

A

When severe and all other has failed

39
Q

You prescribe a doxycycline for a boy with moderate acne. What SE to look out for?

A

photosensitivity, esophagitis, dental staining in children under age 9, teratogenicity, and pseudotumor cerebri

40
Q

How does Isotretinoin combat acne?

A

Reduces sebum production, P. acnes proliferation, and follicular hyperkeratosis, and has anti-inflammatory effects

41
Q

What is chronic nickel contact dermatitis an example of?

A

delayed type IV hypersensitivity reaction

42
Q

What is a dimethylglyoxime test

A

Tests for presence of nickle, helpful for those with an allergy to safe proof home

43
Q

crusty honey colored lesion under nares. what is it and how to treat

A

Impetigo (s. pyogenes or s. aureus), mupirocin

44
Q

MILD topical steroid

A

hydrocortisone acetate, 1% (OTC)

45
Q

Intermediate topical steroid

A

triamcinolone acetonide, 0.1%

46
Q

Potent topical steroid

A

betamethasonedipropionate, 0.05%

47
Q

Class 1/super potent topical steroid

A

clobetasol propionate, 0.05%

48
Q

How much more potent is clobetasol compared to OTC hydrocortisone?

A

1000 x more potent

49
Q

SE of topical steroid use

A

Skin atrophy
Telangiectasias
Hypopigmentation
Suppression of the hypothalamic-pituitary axis

50
Q

Is ringworm acutally caused by a worm?

A

NO, fungus

51
Q

You suspect a child has ringworm based on clinical exam, but you want to confirm the diagnosis. How to do it?

A

KOH wet-mount examination of skin scrapings

52
Q

Tinea versicolor

A

malassezia species - pink, brown, or white lesions, Excess heat and humidity predispose to the infection.
First-line treatment is selenium sulfide lotion.

53
Q

Treatment for tinea capitus?

A

Oral griseofulvin

54
Q

3 causes of diaper rash

A

Irritant dermatitis
Diaper candidiasis
Bacterial infection, especially caused by perianal Group A streptococcus

55
Q

skin folds, satellite lesions, bright red

A

diaper candidiasis

56
Q

Which antifungal is approved for use in children?

A

nystatin (AVOID the azoles)

57
Q

rare systemic causes of diaper rash

A

zinc deficiency, and Langerhans Cell Histiocytosis.

Pediatrics AQ cases (13 decks)

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