3-25 Pediatric Clinical Pathology II Flashcards
What are the demographics of seizure in kids? What makes it more likely?
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
Describe the differences between simple and complex seizures.
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
What is Duchene’s muscular dystrophy? What are the genetics?
Progressive degeneration of skeletal muscle
1:3500 male births
X-linked recessive
Early onset, symmetrical, begins w/ pelvic/pectoral girdle involvement
What is the progression for Duchene’s muscular dystrophy? What is a sign for it?
Confined to wheelchair by adolescence
Death from cardioresp. Insufficiency by age 20
Gower maneuver
What is developmental hip dysplasia? What are the demographics for it?
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
Describe risk factors, PE, clinical findings, and imaging for developmental hip dysplasia.
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)
Describe physiologic genu varum: who gets it, what it looks like, gait, associations and treatment.
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
Describe physiologic genu valgum, who gets it, what it’s associated with, and what the treatment is.
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
What is nursemaid’s elbow? How is it fixed?
Radial head subluxation
Supination-flexion technique
Hyperpronation/forced pronation technique
What is a SCFE? Who gets it?
SCFE occurs when the epiphysis slips off the end of the femur
Overweight 11-16 yo
boys>girls;
AA>whites
How does SCFE present?
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
What does SCFE look like on Xray? What is the Tx and possible complications?
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
What is Legg-Calve-Perthes disease? Who gets it?
Aka Perthes Disease
Idiopathic avascular necrosis of the femoral head
4-11 year old, usu. unilateral
M>F
How does LCPD usually present? What are the SSXs? Imaging and treatment?
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
What is Osgood-Schlatter disease? Who gets it, and what is it caused by?
Traction apophysitis of tibial tubercle
M>F
Cause:
◦Differential rates of osseous & soft tissues
◦Stress on apophyses by vigorous physical activity
What is the presentation and pathophysiology of septic arthritis and osteomyelitis?
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
What are the pathogens that can cause septic arthritis?
◦Neonates: Staph aureus, E coli, GBS
◦Older children: Staph aureus, MRSA
also: Neisseria, GAS, and Salmonella
What are the pathogens that can cause osteomyelitis?
Osteomyelitis pathogens:
◦Staph aureus, Strep pyogenes, Strep pneumoniae
What causes hand-foot-mouth? Who is at risk? What is the course of the illness?
Coxsackie A 16
At risk: preschoolers
Highly contagious
Incubation: 4-6 days
Prodrome: 1-2 days before rash
What is the presentation of hand-foot mouth disease?
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
What causes erythema infectiosum? Who is at risk? What is the season and incubation?
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
What is the clinical course of 5th disease? Who is it dangerous for?
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
What is roseola infantum? Who is at risk? What is the season and incubation?
Aka Exanthem subitum
Human Herpes Virus 6 (7)
At risk 6-36 months (peak 6-7 months)
Season: sporadic
Incubation: 9 days
What is the course of roseola infantum? What are the SSXs, and associated symptoms?
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
What is herpetic gingivostomatitis? What are the SSXs, and what is it important to differentiate it from? Tx?
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
What is herpetic whitlow? What does it look like? How is it treated?
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
What is the prodroma of meningitis? What are the signs of acute disease?
Prodrome few hrs to 5 days
◦URI, nasopharyngitis w/ fever
Abrupt change
◦Vomiting
◦Irritability (“inconsolable”)
◦Nuchal rigidity
◦Bulging fontanelle
What is meningococcemia? What are the associated symptoms and complications?
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
What is Rocky Mountain Spotted Fever? What is the reservoir, vector, season, and incubation?
Acute, potentially severe exanthematous disease
Cause: Rickettsia rickettsii - Obligate intracellular parasites
Transmitted by infected tick
Spring/summer
Incubation: 2-14 days
What is the presentation and Tx of Rocky Mtn Spotted Fever?
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
Name 13 different causes of common pediatric rashes.
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
What are the SSXs of measles?
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
What are the SSXs of molluscum?
◦flesh-colored, umbilicated papules
What are the SSXs of scarlet fever (scarlatina)?
◦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
What are the general SSXs of viral skin infections?
◦Maculopapular rash, often viral respiratory prodrome
What are 5 different types of hypersensitivity reactions, and the general appearance of each.
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
What is the dermal appearance of the vasculitides IgA vasculitis and Kawasaki disease?
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
There’s some more rashes, flip the card and take a look.
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
