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n507 exam 3 > (18) Peds Tables > Flashcards

(18) Peds Tables Flashcards

1
Q

Erythema Toxicum

A

These common yellow or white pustules

are surrounded by a red base.

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2
Q

Neonatal Acne

A

Red pustules and papules are most
prominent over the cheeks and nose of
some normal newborns.

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3
Q

Seborrhea

A

The salmon red, scaly eruption often
involves the face, neck, axilla, diaper
area, and behind the ears

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4
Q

Atopic Dermatitis (Eczema)

A

Erythema, scaling, dry skin, and intense itching characterize this condition.

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5
Q

Neurofibromatosis

A

Characteristic features include more than
5 café-au-lait spots and axillary freckling.
Later findings include neurofibromas and
Lisch nodules (not shown).

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6
Q

Candidal Diaper Dermatitis

A

This bright red rash involves the
intertriginous folds, with small “satellite
lesions” along the edges

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7
Q

Contact Diaper Dermatitis

A

This irritant rash is secondary to diarrhea
or irritation and is noted along contact
areas (here, the area touching the diaper).

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8
Q

Impetigo

A

This infection is due to bacteria and can
appear bullous or crusty and yellowed
with some pus

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9
Q

Verruca Vulgaris

A

Dry, rough warts on hands

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10
Q

Verruca Plana

A

Small, flat warts

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11
Q

Plantar Warts

A

Tender warts on feet

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12
Q

Molluscum Contagiosum

A

Dome-shaped, fleshy lesions

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13
Q

Adolescent Acne

A

Acne in adolescents involves open comedones (blackheads) and closed comedones
(whiteheads) shown at the left, and inflamed pustules (right).

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14
Q

Bites

A

Intensely pruritic, red, distinct papules

characterize these lesions

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15
Q

Tinea Capitis

A

Scaling, crusting, and hair loss are seen in
the scalp, along with a painful plaque
(kerion) and occipital lymph node (arrow).

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16
Q

Urticaria (Hives)

A

This pruritic, allergic sensitivity reaction

changes shape quickly

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17
Q

Scabies

A

Intensely itchy papules and vesicles,
sometimes burrows, most often on
extremities

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18
Q

Tinea Corporis

A

This annular lesion has central clearing

and papules along the border.

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19
Q

Pityriasis Rosea

A

Oval lesions on trunk, in older children, often
in a Christmas tree pattern, sometimes a
herald patch (a large patch that appears first)

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20
Q

Cephalohematoma

A

Although not present at birth, cephalohematomas appear within the
first 24 hours from subperiosteal hemorrhage involving the outer
table of one of the cranial bones. The swelling, shown at the arrow,
does not extend across a suture though it is occasionally bilateral
following a difficult birth. The swelling is initially soft, then develops
a raised bony margin within a few days from calcium deposits at the
edge of the periosteum. It tends to resolve within several weeks

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21
Q

Hydrocephalus

A
  • the anterior fontanelle is bulging
  • the eyes may be deviated downward revealing the upper scleras and creating the setting sun sign (setting sun sign is also seen briefly in some normal newborns)
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22
Q

Craniosynostosis

A

Craniosynostosis is a condition of premature closure of one or more
sutures of the skull. This results in an abnormal growth and shape of
the skull because growth will occur across sutures that are not
affected but not across sutures that are affected.
The figures demonstrate different skull shapes associated with the
various types of craniosynostosis. The prematurely closed suture line is
noted by the absence of a suture line in each figure. Scaphocephaly and
frontal plagiocephaly are the most common forms of craniosynostosis.
The blue shading shows areas of maximal flattening. The red arrows
show the direction of continued growth across the sutures, which is
normal.

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23
Q

Fetal Alcohol Syndrome

A

Babies born to women with chronic alcoholism are at increased
risk for growth deficiency, microcephaly, and intellectual
disability. Facial characteristics include short palpebral fissures,
a wide and flattened philtrum (the vertical groove in the
midline of the upper lip), and thin lips

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24
Q

Congenital Hypothyroidism

A

The child with congenital hypothyroidism (cretinism) has
coarse facial features, a low-set hair line, sparse eyebrows, and
an enlarged tongue. Associated features include a hoarse cry,
umbilical hernia, dry and cold extremities, myxedema,
mottled skin, and intellectual disability. Most infants with
congenital hypothyroidism have no physical stigmata; this has
led to screening of all newborns in the United States and most
other developed countries for congenital hypothyroidism.

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25
Q

Congenital Syphilis

A

In utero infection by Treponema pallidum usually occurs after
the 16th week of gestation and affects virtually all fetal organs.
If it is not treated, 25% of infected babies die before birth and
another 30% shortly thereafter. Signs of illness appear in
survivors within the first month of life. Facial stigmata often
include bulging of the frontal bones and nasal bridge
depression (saddle nose), both from periostitis; rhinitis from
weeping nasal mucosal lesions (snuffles); and a circumoral rash.
Mucocutaneous inflammation and fissuring of the mouth and
lips (rhagades), not shown here, may also occur as stigmata of
congenital syphilis, as may craniotabes tibial periostitis (saber
shins) and dental dysplasia (Hutchinson teeth—see p. 296).

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26
Q

Facial Nerve Palsy

A

Peripheral (lower motor neuron) paralysis of the facial nerve
may be from (1) an injury to the nerve from pressure during
labor and birth, (2) inflammation of the middle ear branch of
the nerve during episodes of acute or chronic otitis media, or
(3) unknown causes (Bell palsy). The nasolabial fold on the
affected left side is flattened, and the eye does not close. This
is accentuated during crying, as shown here. Full recovery
occurs in ≥90% of those affected

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27
Q

Down Syndrome

A

The child with Down syndrome (trisomy 21) usually has a
small, rounded head, a flattened nasal bridge, oblique palpebral
fissures, prominent epicanthal folds, small, low-set, shell-like
ears, and a relatively large tongue. Associated features include
generalized hypotonia, transverse palmar creases (simian lines),
shortening and incurving of the fifth fingers (clinodactyly),
Brushfield spots (see p. 916), and mild to moderate cognitive
impairment.

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28
Q

Battered Child Syndrome

A

The child who has been physically abused (battered) may
have old and fresh bruises on the head and face. Other stigmata
include bruises in areas (axilla and groin) not usually subject
to injury rather than the bony prominences; x-ray evidence of
fractures of the skull, ribs, and long bones in various stages of
healing; and skin lesions that are morphologically similar to
implements used to inflict trauma (hand, belt buckle, strap,
rope, coat hanger, or lighted cigarette). Of note, while many
normal children have bruises on bony prominences, abused
children are more likely to have bruises on protected areas

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29
Q

Perennial Allergic Rhinitis

A

The child suffering from perennial allergic rhinitis has an open
mouth (cannot breathe through the nose) and edema and
discoloration of the lower orbitopalpebral grooves (“allergic
shiners”). Such a child is often seen to push the nose upward
and backward with a hand (“allergic salute”) and to grimace
(wrinkle the nose and mouth) to relieve nasal itching and
obstruction.

30
Q

Hyperthyroidism

A

Thyrotoxicosis (Graves disease) occurs in approximately 2 per
1,000 children younger than 10 years. Affected children exhibit
tachycardia, hypermetabolism, and accelerated linear growth.
Facial characteristics shown in this 6-year-old girl are “staring”
eyes (not true exophthalmos, which is rare in children) and an
enlarged thyroid gland (goiter).

31
Q

Brushfield Spots

A

These abnormal speckling spots on the iris suggest Down

syndrome

32
Q

Strabismus

A

Strabismus, or misalignment of the eyes, can lead to visual

impairment. Esotropia, shown here, is an inward deviation.

33
Q

Otitis Media

A

Otitis media is one of the most common conditions in young children. The spectrum of otitis media is shown here. A: Typical
acute otitis media with a red, distorted, bulging tympanic membrane in a highly symptomatic child. B: Acute otitis media with
bullae formation and fluid visible behind the tympanic membrane. C: Otitis media with effusion, showing a yellowish fluid
behind a retracted and thickened tympanic membrane. Often you can no longer visualize the normal landmarks such as the
light reflex and handle of the malleus

34
Q

Oral Candidiasis (“Thrush”)

A

This infection is common in infants. The white plaques do not
rub off

35
Q

Herpetic Stomatitis

A

Tender ulcerations on the oral mucosa are surrounded by

erythema

36
Q

Dental Caries

A

Dental caries is a major global health and pediatric
problem. White spots on the teeth often reflect early
caries. The photographs to the left show different
characteristics of caries

37
Q

Staining of the Teeth

A

Various causes can lead to staining of the teeth of children, including intrinsic stains
such as tetracycline (left) or extrinsic stains such as poor oral hygiene (not shown).
Extrinsic stains can be removed

38
Q

Streptococcal Pharyngitis

“Strep Throat”

A

This common childhood infection has a classic
presentation of erythema of the posterior pharynx
and palatal petechiae. A foul-smelling exudate is
also commonly noted

39
Q

Lymphadenopathy

A

Enlarged and tender cervical lymph nodes are common in children. The most likely
causes are viral and bacterial infections. Lymph node enlargement can be bilateral, as
shown in the figure to the left.

40
Q

Generalized Cyanosis

A

This baby has total anomalous pulmonary venous return and

an oxygen saturation level of 80%.

41
Q

It is important to recognize cyanosis:

A

The best location to examine is the mucous membranes. Cyanosis is a “raspberry” color,
whereas normal mucous membranes should have a “strawberry” color.

42
Q

Perioral Cyanosis

A

This baby has mild cyanosis above the lips, but the mucous

membranes remain pink

43
Q

Bluish Lips, Giving Appearance of Cyanosis

A

Normal pigment deposition in the vermilion border of the lips
gives them a bluish hue, but the mucous membranes are pink

44
Q

Acrocyanosis

A

This commonly appears on the feet and hands of babies

shortly after birth. This infant is a 32-week-old newborn

45
Q

Pulmonary Valve Stenosis

A

Usually a normal valve annulus with
fusion of some or most of the valve
leaflets, restricting flow across the valve

46
Q

Pulmonary Valve Stenosis:

Characteristics of the Murmur

A 
Location. Upper left sternal border
Radiation. In mild degrees of stenosis,
the murmur may be heard over the
course of the pulmonary arteries in the
lung fields.
Intensity. Increases in intensity and
duration as the degree of obstruction
increases
Quality. Ejection, peaking later in systole
as the obstruction increases
47
Q

Pulmonary Valve Stenosis (kids):

associated findings

A 
Usually a prominent ejection click in
early systole
Pulmonary component of the second
sound at the base (P2) becomes delayed
and softer, disappearing as obstruction
increases. Inspiration may increase
murmur; expiration may increase click.
Growth is usually normal.
Newborns with severe stenosis may
be cyanotic from right-to-left atrial
shunting and rapidly develop heart
failure as the ductus arteriosus closes
48
Q

Aortic Valve Stenosis

A 
Usually a bicuspid valve with progressive
obstruction, but may occur as a result
of a dysplastic valve or damage from
rheumatic fever or degenerative disease
S1
49
Q

Aortic Valve Stenosis: characteristics

A 
Location. Midsternum, upper right
sternal border
Radiation. To the carotid arteries and
suprasternal notch; may also be a thrill
Intensity. Varies, louder with increasingly
severe obstruction
Quality. An ejection, often harsh,
systolic murmur
50
Q

Aortic Valve Stenosis: associated findings in kids

A 
May be an associated ejection click
The aortic closure sound may be
increased in intensity. There may be a
diastolic murmur of aortic valve
regurgitation (not shown in the
diagram). Newborns with severe
stenosis may have weak or absent pulses
and severe heart failure. May not be
audible until adulthood even though
the valve is congenitally abnormal
51
Q

Tetralogy of Fallot

A

Complex defect with ventricular septal
defect, infundibular and usually valvular
right ventricular outflow obstruction,
malrotation of the aorta, and right-to-left
shunting at ventricular septal level

52
Q

Tetralogy of Fallot: characteristics

A 
General. Variable cyanosis, increasing
with activity
Location. Mid-to-upper left sternal
border. If pulmonary atresia, the
continuous murmur of ductus
arteriosus flow at upper left sternal
border or in the back.
Radiation. Little, to upper left sternal
border, occasionally to lung fields
Intensity. Usually grade III–IV
Quality. Systolic ejection murmur
53
Q

Tetralogy of Fallot: associated findings in kids

A

Normal pulses
The pulmonary closure sound is usually
not heard. May have abrupt
hypercyanotic spells with sudden
increase in cyanosis, air hunger, altered
level of awareness
Failure to gain weight with persistent and
increasingly severe cyanosis
Long-term persistence of cyanosis accompanied
by clubbing of fingers and toes
Persistent hypoxemia leads to polycythemia,
which will accentuate the cyanosis.

54
Q

Transposition of the Great Arteries

A

A severe defect with failure of rotation of
the great vessels, leaving the aorta to arise
from the right ventricle and the
pulmonary artery from the left ventricle

55
Q

Transposition of the Great Arteries: characteristics

A 
General. Intense generalized cyanosis
Location. No characteristic murmur. If
present, it may reflect an associated defect
such as ventricular septal defect (VSD).
Radiation and Quality. Depends on
associated abnormalities
56
Q

Transposition of the Great Arteries: associated findings in kids

A 
Single loud second sound of the
anterior aortic valve
Frequent rapid development of heart
failure
Frequent associated defects as described
at the left
57
Q

Ventricular Septal Defect

A 
Blood going from a high-pressure left
ventricle through a defect in the septum
to the lower-pressure right ventricle
creates turbulence, usually throughout
systole.
58
Q

Ventricular Septal Defect: characteristics

A 
Location. Lower left sternal border
Radiation. Little
Intensity. Variable, only partially
determined by the size of the shunt.
Small shunts with a high-pressure
gradient may have very loud murmurs.
Large defects with elevated pulmonary
vascular resistance may have no
murmur. Grade II–IV/VI with a thrill if
grade IV/VI or higher.
Quality. Pansystolic, usually harsh, may
obscure S1 and S2 if loud enough
59
Q

Ventricular Septal Defect: associated findings in kids

A 
With large shunts, there may be a lowpitched
middiastolic murmur of relative
mitral stenosis at the apex.
As pulmonary artery pressure increases,
the pulmonic component of the second
sounds at the base increases in intensity.
When pulmonary artery pressure equals
aortic pressure there may be no murmur
and P2 will be very loud.
In low-volume shunts, growth is
normal.
In larger shunts, heart failure may occur
by 6–8 wks; poor weight gain, poor
feeding.
Associated defects are frequent.
60
Q

Patent Ductus Arteriosus

A

Continuous flow from aorta to
pulmonary artery throughout the cardiac
cycle when ductus arteriosus does not
close after birth

61
Q

Patent Ductus Arteriosus: characteristics

A 
Location. Upper left sternal border and
to left
Radiation. Sometimes to the back
Intensity. Varies depending on size of
the shunt, usually grade II–III/VI.
Quality. A rather hollow, sometimes
machinery-like murmur that is
continuous throughout the cardiac
cycle, although occasionally almost
inaudible in late diastole, uninterrupted
by the heart sounds, louder in systole
62
Q

Patent Ductus Arteriosus: associated findings in kids

A 
Full to bounding pulses
Noticed at birth in the premature infant
who may have bounding pulses, a
hyperdynamic precordium, and an
atypical murmur
Noticed later in the full-term infant as
pulmonary vascular resistance falls
May develop heart failure at 4–6 wks if
large shunt
Poor weight gain related to size of shunt
Pulmonary hypertension affects
murmur as above
63
Q

Atrial Septal Defect

A

Left-to-right shunt through an opening in

the atrial septum, possible at various levels

64
Q

Atrial Septal Defect: characteristics

A 
Location. Upper left sternal border
Radiation. To the back
Intensity. Variable, usually grade II–III/VI
Quality. Ejection but without the harsh
quality
65
Q

Atrial Septal Defect: associated findings in kids

A 
Widely split second sounds throughout
all phases of respiration, normal
intensity
Usually not heard until after age of 1 yr
Gradual decrease in weight gain as
shunt increases
Decreased exercise tolerance, subtle, not
dramatic
Heart failure is rare
66
Q

Physical Signs of Sexual Abuse: possible indications

A
  1. Marked and immediate dilatation of the anus in knee–chest position, with no constipation, stool in the vault, or neurologic
    disorders
  2. Hymenal notch or cleft that extends >50% of the inferior hymenal rim (confirmed in knee–chest position)
  3. Condyloma acuminata in a child older than 3 yrs
  4. Bruising, abrasions, lacerations, or bite marks of labia or perihymenal tissue
  5. Herpes of the anogenital area beyond the neonatal period
  6. Purulent or malodorous vaginal discharge in a young girl (culture and view all discharges under a microscope for evidence of
    a sexually transmitted infection)
67
Q

Physical Signs of Sexual Abuse: strong indications

A
  1. Lacerations, ecchymoses, and newly healed scars of the hymen or the posterior fourchette
  2. No hymenal tissue from 3 o’clock to 9 o’clock (confirmed in various positions)
  3. Healed hymenal transections especially between 3 and 9 o’clock (complete cleft)
  4. Perianal lacerations extending to external sphincter
68
Q

Hypospadias

A

Hypospadias is the most common congenital penile
abnormality. The urethral meatus opens abnormally on the
ventral surface of the penis. One form is shown above; more
severe forms involve openings on the lower shaft or scrotum

69
Q

Undescended Testicle

A

You should distinguish between undescended testes, shown
above, (with testes in the inguinal canals—see arrows), from
highly retractile testes from an active cremasteric reflex

70
Q

Common Musculoskeletal Findings in Young Kids

A
  • Flat feet or pes planus from laxity of the
    soft tissue structures of the foot
  • Inversion of the foot (varus) - - Metatarsus adductus in a child. The
    forefoot is adducted and not inverted
  • Pronation in a toddler. A: When viewed from behind, the hindfoot is everted. B: When viewed from the front, the forefoot is
    everted and abducted
71
Q

Table 18-14: Vaccine Preventable Diseases

A

pg. 923

pictures but no real info

n507 exam 3 (12 decks)

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