3-25 Pediatric Clinical Pathology II

Question 1

What are the demographics of seizure in kids? What makes it more likely?

Answer 1

—3-5% of healthy toddlers will have seizure caused fever (9m-5 yrs)

—Tends to run in families

—Likely to have more than one febrile seizure if:

◦There is a family history of febrile seizures

◦The first seizure happened before age 12 months

◦The seizure occurred with a fever below 102oF

Question 2

Describe the differences between simple and complex seizures.

Answer 2

Simple febrile seizure

Lasts a few seconds to 5-10 minutes

Followed by a period of drowsiness or confusion (30 minutes post-ictal)

Complex febrile seizure

lasts longer than 15 minutes

In just one part of the body

Occurs again during the same illness

Question 3

What is Duchene’s muscular dystrophy? What are the genetics?

Answer 3

—Progressive degeneration of skeletal muscle

—1:3500 male births

—X-linked recessive

—Early onset, symmetrical, begins w/ pelvic/pectoral girdle involvement

Question 4

What is the progression for Duchene’s muscular dystrophy? What is a sign for it?

Answer 4

—Confined to wheelchair by adolescence

—Death from cardioresp. Insufficiency by age 20

—Gower maneuver

Question 5

What is developmental hip dysplasia? What are the demographics for it?

Answer 5

Displacement of femoral head from normal relationship w/ acetabulum

• 1 or 2 in 1000 births
• F>M
• Unilateral 2X as frequent as bilateral
• Varying severities

Question 6

Describe risk factors, PE, clinical findings, and imaging for developmental hip dysplasia.

Answer 6

Risk factors: In utero positioning, Breech presentation

PE: Ortolani/Barlow maneuvers

—Findings:

◦Femoral head lateral & superior to normal position

◦Acetabulum may be shallow

Imaging:

US ideally at six weeks, or

Xray AP frog leg 4-6 months (ossification not begun till that time)

Question 7

Describe physiologic genu varum: who gets it, what it looks like, gait, associations and treatment.

Answer 7

Bowlegged

Seen in 1-3 yr olds

Associated w/ laxity of other joints & internal tibial torsion

Waddling gait or kick heels

Tx: rarely indicated, resolves w/ growth

Question 8

Describe physiologic genu valgum, who gets it, what it’s associated with, and what the treatment is.

Answer 8

Knock-kneed

Seen in 3-5 yr olds

F>M

May be associated w/ ligamentous laxity

r/o rickets/renal dz

Tx: not generally indicated, corrects w/ time

Question 9

What is nursemaid’s elbow? How is it fixed?

Answer 9

Radial head subluxation

Supination-flexion technique
Hyperpronation/forced pronation technique

Question 10

What is a SCFE? Who gets it?

Answer 10

SCFE occurs when the epiphysis slips off the end of the femur

Overweight 11-16 yo

boys>girls;

AA>whites

Question 11

How does SCFE present?

Answer 11

Pain in hip, thigh, groin, or knee

Stable-can walk with or without crutches

◦Leg maybe stiff, limp, or painful (comes & goes)

◦Leg may externally rotate or appear shorter

Unstable-very painful; pt will not want to move leg

Question 12

What does SCFE look like on Xray? What is the Tx and possible complications?

Answer 12

Diagnosed with x-ray

femoral head displaced medially in relation to neck

Widened physis

Step off (late sign)

Treatment is surgery (screw)

Complications include avascular necrosis and chondrilysis

Question 13

What is Legg-Calve-Perthes disease? Who gets it?

Answer 13

—Aka Perthes Disease

—Idiopathic avascular necrosis of the femoral head

—4-11 year old, usu. unilateral

M>F

Question 14

How does LCPD usually present? What are the SSXs? Imaging and treatment?

Answer 14

Painless limp or complain of thigh, hip, groin or knee pain, fatigue w/ walking or hip stiffness.

Leg is held is external rotation.

+Trendelenberg sign on involved side

Flattened or fragmented femoral head (late finding)

femoral epiphysis flattened, proximal femur displaced inferior & laterally on xray

Tx-observation, NSAIDS, casting, bracing or surgery if severe

Question 15

What is Osgood-Schlatter disease? Who gets it, and what is it caused by?

Answer 15

—Traction apophysitis of tibial tubercle

—M>F

—Cause:

◦Differential rates of osseous & soft tissues

◦Stress on apophyses by vigorous physical activity

Question 16

What is the presentation and pathophysiology of septic arthritis and osteomyelitis?

Answer 16

—Presenting symptoms: Fever, bone pain, swelling, redness, limp

—Pathophysiology:

◦hematogenous spread to the synovium

◦rich vascular supply in their growing bones

—Neonates and young children often have coexisting septic arthritis and osteomyelitis

Question 17

What are the pathogens that can cause septic arthritis?

Answer 17

◦Neonates: Staph aureus, E coli, GBS

◦Older children: Staph aureus, MRSA

also: Neisseria, GAS, and Salmonella

Question 18

What are the pathogens that can cause osteomyelitis?

Answer 18

—Osteomyelitis pathogens:

◦Staph aureus, Strep pyogenes, Strep pneumoniae

Question 19

What causes hand-foot-mouth? Who is at risk? What is the course of the illness?

Answer 19

—Coxsackie A 16

—At risk: preschoolers

—Highly contagious

—Incubation: 4-6 days

—Prodrome: 1-2 days before rash

Question 20

What is the presentation of hand-foot mouth disease?

Answer 20

—Low grade fever, anorexia, malaise, sore throat

—Painful, shallow, yellow ulcers surrounded by red halos

◦Found on buccal mucosa, tongue, soft palate, uvula and anterior tonsillar pillars

—Oral lesions without the exanthem = herpangina

—Exanthem involves palmar, plantar and interdigital surfaces of the hands and feet +/- buttocks

Question 21

What causes erythema infectiosum? Who is at risk? What is the season and incubation?

Answer 21

Erythema infectiosum - 5th disease

—Parvovirus B19

—At risk: school age children (4-10)

—Season: sporadic

—Incubation: 4-14 days

—Infectious: until the onset of the rash

Question 22

What is the clinical course of 5th disease? Who is it dangerous for?

Answer 22

—Rash on face is characteristic “slapped cheek” appearance

—>50% asymptomatic

—Prodrome

◦Mild fever (15-30%), sore throat, malaise

—Dangerous for pregnant women in 1st trimester

◦Can cause hydrops fetalis

Question 23

What is roseola infantum? Who is at risk? What is the season and incubation?

Answer 23

—Aka Exanthem subitum

—Human Herpes Virus 6 (7)

—At risk 6-36 months (peak 6-7 months)

—Season: sporadic

—Incubation: 9 days

Question 24

What is the course of roseola infantum? What are the SSXs, and associated symptoms?

Answer 24

—Infectious: until onset of rash

—High fever for 3-4 days

—Abrupt drop in fever with appearance of rash

—Associated seizures likely due to infection of the meninges by the virus

Question 25

What is herpetic gingivostomatitis? What are the SSXs, and what is it important to differentiate it from? Tx?

Answer 25

—Human Herpes Virus 1

—Gingivostomatitis most common 1º infection in children

◦Fever, irritability, cervical nodes

◦Small yellow ulcerations with red halos on mucous membranes

—Involvement more diffuse – easy to differentiate from herpangina and exudative tonsillitis

—Treatment: supportive

Question 26

What is herpetic whitlow? What does it look like? How is it treated?

Answer 26

—Lesions on thumb usually 2° to autoinoculation

—Group, thick-walled vesicles on erythematous base

—Painful

—Tend to coalesce, ulcerate and then crust

—May require topical or oral acyclovir

Question 27

What is the prodroma of meningitis? What are the signs of acute disease?

Answer 27

—Prodrome few hrs to 5 days

◦URI, nasopharyngitis w/ fever

—Abrupt change

◦Vomiting

◦Irritability (“inconsolable”)

◦Nuchal rigidity

◦Bulging fontanelle

Question 28

What is meningococcemia? What are the associated symptoms and complications?

Answer 28

—10% infants show overwhelming sepsis

◦Little to no initial lab evidence of meningitis

—See same abrupt change

◦In addition, rash in association w/ shock

—85% show rash on trunk/extremities

◦May progress to frank necrosis

◦Death can occur in 24 hours of presentation

Question 29

What is Rocky Mountain Spotted Fever? What is the reservoir, vector, season, and incubation?

Answer 29

—Acute, potentially severe exanthematous disease

—Cause: Rickettsia rickettsii - Obligate intracellular parasites

—Transmitted by infected tick

—Spring/summer

—Incubation: 2-14 days

Question 30

What is the presentation and Tx of Rocky Mtn Spotted Fever?

Answer 30

—Sx: fever, HAs, anorexia, N/V/D, sore throat, myalgias

◦Rash spread most distinguishing feature: begins distally (erythemaous, blanching, fine, maculopapular), spreads centripetally & becomes petechial

◦Often see conjunctival erythema, edema and photophobia w/ rash

—Test: for rickettsia (takes at least 1 wk)

—Must treat immediately if suspected

◦Doxycycline (in all children)

◦If treat within first week prognosis is good

Question 31

Name 13 different causes of common pediatric rashes.

Answer 31

Candida

Chicken pox (varicella)

Erythema infectiosum (5th disease)

Lyme

Measles

Meningococcemia

Molluscum

Roseola infantum

Rubella

Scarlet fever (scarlatina)

Staph Scalded Skin Syndrome

Tinea

Viral infections

Question 32

What are the SSXs of measles?

Answer 32

—Measles

◦Maculopapular rash beginning on the face and spreading to the trunk and extremities

◦Often Koplik spots (white spots on buccal mucosa)

◦Fever, cough, coryza, conjunctival injection

Question 33

What are the SSXs of molluscum?

Answer 33

◦flesh-colored, umbilicated papules

Question 34

What are the SSXs of scarlet fever (scarlatina)?

Answer 34

◦Generalized fine, red, rough-textured, blanching rash that typically appears 12–72 h after the fever and starts on the chest, in the armpits, and on the groin

◦Characteristic pale area around the mouth (circumoral pallor) and accentuation in the skinfolds (Pastia lines), strawberry tongue

Question 35

What are the general SSXs of viral skin infections?

Answer 35

◦Maculopapular rash, often viral respiratory prodrome

Question 36

What are 5 different types of hypersensitivity reactions, and the general appearance of each.

Answer 36

—Atopic dermatitis (eczema)

—Contact dermatitis

◦itchy erythema, sometimes with vesicles

◦No systemic manifestations

—Drug eruption

◦Diffuse maculopapular rash

◦History of current or recent (within 1 wk) drug use

—Stevens Johnsons

◦Painful mucosal ulcers, almost always in the mouth and lips but sometimes in the genital and anal regions

—Urticaria

◦Well-circumscribed, pruritic, red, raised lesions

◦With or without history of exposure to known or potential allergens

Question 37

What is the dermal appearance of the vasculitides IgA vasculitis and Kawasaki disease?

Answer 37

—IgA Vasculitis (HSP)

◦Palpable purpura in buttocks/lower extremities, abdominal pain, arthritis

—Kawasaki

◦Diffuse erythematous maculopapular rash

◦Must have fever (often > 39° C) for > 5 days

◦Red, cracked lips, strawberry tongue, conjunctivitis, cervical lymphadenopathy, swelling of hands/feet

Question 38

There’s some more rashes, flip the card and take a look.

Answer 38

—Seborrheic dermatitis

—Irritant diaper rash

—HUS - ◦Petechiae, HTN, oligura, presents after bloody diarrhea

—EM - target-like lesion

—Milia - Small pearly cysts on a neonate’s face

—Miliaria rubra (heat rash) - Small red bumps

—Erythema toxicum - Flat red splotches (usually with a white, pimple-like bump in the middle), which appear in up to half of all babies

—Acne

—Pityriasis rosea - red herald patch, then “Christmas tree” rash