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1
Q

Roseola

A

A viral exanthem that classically follows 3-5 days of a febrile illness.

As the fever resolves, patients develop a pink, maculopapular rash that starts on the trunk and may spread to the face and extremities.

Caused by human herpes virus-6 (HHV-6).

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2
Q

Papular urticaria

A

Caused by insect bites.
Papular 3 mm to 10 mm in diameter.
Can be recurrent or chronic.
Pruritic.

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3
Q

Sandpaper rash

A

Strep infection, scarlet fever.

Accentuated at skin creases.

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4
Q

Erythema multiforme

A

An acute hypersensitivity syndrome - HSV or medications.

Symmetrical rash starts as a dusky red macules and evolves into sharply demarcated wheals and then into target-like lesions.

Individual lesions stay fixed for 1-3 weeks.

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5
Q

Erythema infectiosum (Fifth disease)

A

Parvovirus B19

“slapped”-cheek appearance followed by a reticular (lacy) erythematous rash on the trunk and extremities.

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6
Q

Erythema migrans

A

Early localized Lyme disease.
Starts as a red papule at the site of a tick bite.
Expands to form a large erythematous, annular patch.

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7
Q

Seborrheic dermatitis (cradle cap)

A

From malassezia.
Erythematous plaques with fine to thick, greasy yellow scale.
Typically seen on the scalp, but may spread elsewhere

Treat with baby oil, antifungal shampoo or creams (older kids)

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8
Q

Eczema vs psoriasis

A

Eczema: pruritic, erythematous, scaling plaques on extensor surfaces
Psoriasis: More erythematous, with a thicker, non-waxy scale and more defined borders

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9
Q

Pseudofolliculitis

A

Papules, but not pustules

Around hair follicles

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10
Q

Acne vulgaris

A

Keratinous material and excess sebum (due to androgenic influence) plug the pilosebaceous gland.
Or
Increased sebum provides growth medium for superinfection with Propioniobacterium acnes.

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11
Q

Hidradenitis suppurativa

A

Pustular lesions caused by occlusion of the apocrine follicular units (instead of the pilosebaceous units).

Often superinfected with Staph aureus or Strep pyogenes.

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12
Q

Rosacea

A

No comedones.

Worsens with alcohol, spicy food, temperature extremes, and stress.

Can be treated with topical metronidazole and various other medications.

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13
Q

Perioral dermatitis

A

variant of rosacea, treated the same way.

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14
Q

Acne severities

A

Mild - Comedonal acne with perhaps a few papules or pustules mixed in.
Tx OTC benzoyl peroxide or retinoids

Moderate - Significant inflammatory lesions with concern for scarring.
Tx topical antibiotic like clindamycin or erythromycin. Oral therapy includes abx like doxycycline or tetracycline, or contraceptive pills.

Severe - Nodulo-cystic type, with an even higher risk for significant scarring
Tx should be referred to a dermatologist. They will use oral isotretinoin.

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15
Q

Nickel contact dermatitis hypersensitivity type

A

delayed type IV hypersensitivity reaction

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16
Q

Impetigo

A

Usually Staphylococcus aureus and Streptococcus pyogenes

Tx with topical mupirocin.

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17
Q

Steroid potencies

A

Mild - hydrocortisone acetate, 1% (OTC)

Intermediate - triamcinolone acetonide, 0.1%

Potent - betamethasonedipropionate, 0.05%

Super potent - clobetasol propionate, 0.05%

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18
Q

Pediculosis Capitis (Head Lice)

A

No need to treat for lice prophylactically

1st-line treatment - 1% permethrin lotion

2nd line Benzyl alcohol 5% (>6 mo age)
or malathion 0.5% (>2y age)

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19
Q

Scabies

A

Caused by a mite, Sarcoptes scabiei.
Significant itching especially at night.
Classic lesion for scabies is about a 5-10 mm curvilinear thread-like lesion–the burrow.

Tx - 2 applications of permethrin 5% cream, one week apart, for all affected household members.
2nd line - oral ivermectin

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20
Q

Ringworm (Tinea corporis)

A

Annular, well-circumscribed, scaly plaque with a raised border and a center that is brown or hypopigmented.

Lesions can be mildly pruritic and gradually enlarge and may coalesce with surrounding lesions.

Clinical Dx but can do KOH wet-mount.

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21
Q

Tinea Versicolor

A

Actually from malassezia species.
Pink, brown, or white lesions can increase risk with heat or humidity.
Tx selenium sulfide lotion.

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22
Q

Tinea Capitis

A

ringworm of the scalp
Systemic therapy is required for this type of tinea
Tx griseofulvin 6-8wks.

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23
Q

Pityriasis alba

A

hypopigmentations

Associated with sun exposure.

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24
Q

Pityriasis rosea

A

scaly papules and plaques in the hallmark “christmas tree” distribution on the back and trunk, following the lines of skin cleavage.
initial lesion, called the “herald patch,” is usually the largest scaly plaque with a raised border and can easily be confused with tinea corporis.

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25
Warts treatment
Salicylic acid has best data.
26
Types of diaper rashes
Irritant Dermatitis - most common, from poop/pee. Tx with cleanliness and zinc oxide creams/ointments. Diaper Candidiasis - inflamed plaques have more erythematous papules "satellite" lesions. Tx w/ nystatin. Bacterial Infection - Much less common. Standard treatment with oral antibiotics is effective.
27
Rare systemic illnesses that present w/ diaper rash
Acrodermatitis enteropathica, a rare inherited form of zinc deficiency Langerhans Cell Histiocytosis Refer to dermatology if diaper rash worsens w/ tx
28
vision/hearing screening
Hearing - At birth, then ask parents as baby ages | Vision - screen with vision chart at age 3y.
29
Breastfeeding supplementation
Baby should get 400 IU vit. D daily
30
Timeline for newborn to regain birthweight
Age 2wks.
31
When baby should transition to cow's milk
1yr
32
Caloric requirements for 1-2 month olds
Term - 100-120kcal/kg daily Preterm - 115-130 kcal/kg daily Very preterm (<32wks) - 150 kcal/kg daily
33
Age for flu vaccine
6 months
34
Anticipatory guidance examples
4 months - spoon feeding, sleeping through the night 6 months - rolling over, sits unsupported, walker are NOT recommended! Can introduce solid food. Read! 1yr - Can stop sleeping on back/firm surface. Standing, ~walking, 4 words, playful. 2yr - Rear-facing car seat until age 2. 13yr - sit in back seat.
35
Age to double and triple birth weight
Double at 4-5 months | Triple at 1yr
36
When to refer for abnormal red reflex
Always, especially if leukocoria or signs of abusive trauma.
37
Neuroblastoma prognosis
Metastatic (stage 4s) can regress completely in <1yr olds.
38
Neuroblastoma inheritance
autosomal dominant, low penetrance
39
Initial testing for an abdominal mass in an infant
CBC, catecholamines (VMA, HVA), CXR, skeletal survey, abdominal US and x-ray. CT if non-cystic mass found on US.
40
Ddx of RUQ mass + palor in infant
Hydronephrosis - Will see lots of UTIs. Can be from multicystic kidney. Neuroblastoma - Check for neck, chest, abdomen mass. Sx are fever, pallor, weight loss. Wilms Tumor - Mass doesn't cross midline. HTN, abdominal pain, vomiting. Hepatic Neoplasm - Jaundice notable. Teratoma - Rare. Causes pressure effects on ab organs.
41
3 year old development
Socio-emotional - Brushing teeth, feeds self. Communication - 2-3 word sentences. 75% understandable. Cognitive - Knows name/use of cup, ball, spoon, crayon. Physicial - Can build tower of 6-8 cubes.
42
4 year old development
Socio-emotional - Knows age/gender, plays with others, fantasy play. Communication - Knows first/last name. Can sing. Cognitive - Knows colors, gender, can draw person with 3 parts. Physicial - Hops on one foot.
43
5 year old development
Socio-emotional - Listens, knows difference between real and fake. Sympathy. Communication - Full sentences. Counts to 10. Cognitive - draws person >6 body parts. Physicial - Balances on one foot. Can dress self.
44
What to do if child isn't reaching developmental milestones.
If <3yrs old, refer to early childhood intervention, peds psych, developmental-behavioral peds, or learning specialist. If >3yrs old, school will have some kind of program to catch them up.
45
Treatment of eczema
Lubricate Short burst anti inflammatories Treat any underlying infection Steroids - OTC stuff doesn't work Topical NSAIDS - Calcineurine inhibitors (cyclosporine, tacrolimus) are 2nd line Antihistamines - help with itch
46
When to check serum lead levels in children
If aged 1-2yrs and they have spent >25% of their time in a home built before 1960.
47
Anemia screening for children
At age 1yr and again at start of preschool/kindergarten.
48
Constitutional short stature
"late bloomer" will attain normal height later than peers
49
Female puberty milestones
Onset 8-13yrs | Breast buds + pubic hair (10yrs) -> growth spurt -> periods (12-13yr) -> adult height (15yrs)
50
Male puberty milestones
Onset 10-15yrs Testes enlargement + pubic hair (12yr) -> penile growth + ejaculations (13yr) -> growth spurt (14yr) -> adult height (17yr)
51
mononucleosis sx
Lymphadenopathy, pharyngitis, fatigue
52
How is menses in adolescents different than adults
Increased cramps/discomfort with little bleeding/clots
53
Which adolescents should be screened for suicidality
Everyone
54
Anorexia signs
bradycardia, postural hypotension. | Low glucose, albumin, Na, Mg, Ca
55
Ddx for adolescent worsening school performance
Medical (thyroid) Personal (home problems) Mind (psych conditions) Drugs
56
Weight age and height age
Weight age: age where current weight is at 50th% | Height age: age where current height is at 50th%
57
ADHD symptoms
↓ attention ↑ activity ↑ impulse
58
Ddx for ADHD
``` Sensory deficits Sleep abnormalities Mood disorder Learning disability Conduct disorder ```
59
Red flags for future learning disabilities
Maternal substance abuse Meningitis Head trauma Family hx learning disabilities
60
Stimulants SEs
``` ↓ appetite insomnia ↓ growth No addiction risk Cardiovascular risk only to those with heart disease Can uncover tic disorder ```
61
Obesity risk factors
↑ birth weight maternal diabetes obese parents ↓ socioeconomic status
62
Main obesity complications
``` HTN HLD OSA DMII Fatty liver Slipped capital femoral epiphysis ```
63
DMII Dx criteria
A1c >6.5 Random glucose >200 Fasting >126 GTT >200
64
Screening criteria for DMII in children
BMI >85% + one of: Family Hx, race, maternal DM Screen @ age 10/puberty - Q3yrs
65
Signs of insulin resistance
PCOS, acanthosis nigricans, HTN, HLD
66
HTN categories in children
Pre-HTN 90-95% HTN stage I - 95-99% HTN stage II - >99%
67
How can you tell endocrine problems vs just being obese from diet
Endocrine problems --> short stature
68
Causes of 2ndary HTN
UTI, renal causes, ↑ catecholamines, coarcted aorta
69
How to manage HTN in children
Re-check in 6 months. | Don't do medications unless stage II HTN
70
vWD facts
Most common hereditary bleeding disorder Autosomal dominant w/ variable penetrance (Type I and II) Sx: ecchymoses, epistaxis, menorrhagia, gingival bleeding.
71
vWD diagnosis
theoretically PTT should be prolonged but can be normal. Check von Willebrand factor antigen and/or platelet function analysis and factor VIII levels
72
HEADSSS
``` Home Education/employment Eating disorders Activities Drugs Sexuality Suicide risk Safety ```
73
How to discuss confidentiality
Promising absolute confidentiality yields more information. | Relative confidentiality is less misleading but yields less information.
74
vWD treatment
IV or intranasal desmopressin. Or vW factor concentrate.
75
Diagnosis & management of neonatal hypoglycemia
Reagent strip showing whole blood glucose <40 - Symptomatic -> IV Dextrose - Asymptomatic -> Promote feeding
76
Feeding recommendations for tachypnic neonates
Still try to feed. | If unable to feed -> pump in the meantime.
77
Gestational age categories
SGA - <10% --> risk of polycythemia, temp instability, hypoglycemia AGA - 10-90% LGA - >90% --> ↑ birth injuries, hypoglycemia
78
Vasovagal reflex
Normally has prodromal sx: | dizziness, light headed, sweating, nausea, vision changes
79
Precordial catch syndrome vs costochondritis
Precordial catch: unknown, msk pain lasting seconds | Chostocondritis: msk pain lasting hours-days.
80
signs/sx of cardiac chest pain
``` exertional crushing/pressure 10-15 minutes syncope murmur ```
81
At what stage does "just say no" instruction no longer work
Works for pre-adolescents but doesn't work for adolescents.
82
Male Tanner staging
``` 1 - Pre-puberty 2 - fine hair 3 - coarse hair 4 - scrotal darkening 5 - medial thigh hair ```
83
Immunizations for adolescents
11-12yrs --> TDaP, MCV4 (meningitis), HPV | 16 --> MenB, MCV4 booster
84
Sports exam for males
Check for undescended testes and inguinal hernias | Screen strength, tone, ROM symmetry
85
Syncope evaluation
ECG --> ECHO if exertional to check for hypertrophic cardiomyopathy
86
Differential for tachypnea of newborn
Respiratory distress syndrome - ↓ surfactant. - Up to 37wks. - ↑ risk in diabetic mothers -> ↓ surfactant production - Ground glass appearance of lungs Transient tachypnea of newborn - delayed fluid clearance from birth. -↑ in diabetic mothers and C-sections Pneumothorax - ↑ with mechanical ventilation. -Uncommon Meconium aspiration. Hypoglycemia - It just happens. Hypothermia. Cardiac abnormalities - Transient hypertrophic cardiomyopathy (diabetic -> ↑ organ size) -VSD, PDA, coarctation of aorta. Neonatal sepsis - ↑ risk w/ GBS, long ROM Diaphragmatic hernia - Mostly on left side. ↓ lung development, pushing of heart/mediastinum.
87
Jaundice etiologies
- Breastfeeding jaundice - first few days - ↓ oral intake. - Breast milk jaundice - 1-2wks of life, from the milk deconjugating bili -> ↑ reabsorption. - Hemolysis - RBC breakdown - bruising, swallowed blood - Sepsis - TORCH infections
88
Biliary atresia
-Jaundice -Dark urine -Pale stools Tx: Surgery to prevent early liver damage
89
Normal baby voiding/stooling patterns
Void: 3-4x daily --> 6-8x daily by day 6. Stool: 3-4x daily, meconium ends after day 3.
90
Hemolysis PE findings
Jaundice | Hepatosplenomegaly
91
When to start fluoride
Age 6 months
92
CAH findings
↑ 17-OH --> ↑ androgens --> virilization | ↓ cortisol + aldosterone --> salt wasting: ↓Na, ↓K, ↓H2O
93
Hypothyroid presentation of babies
Normal at birth -> feeding issues, ↓activity, constipation | Over long time -> large tongue, hoarse cry, puffy face
94
What prophylaxis do you give for those with sickle cell
Penicillin to prevent strep pneumonia
95
Poor feeding/decreased activity differential
``` Congenital hypothyroid Shaken baby Down syndrome CAH Metabolic disorders Botulism Polycythemia ```
96
6-mo Fever ddx
``` UTI Pneumonia sepsis meningitis roseola hsv otitis media viral URI ```
97
Infant meningitis signs
``` Fever or low temp bulging fontanelles lethargy crying when picked up vomiting/diarrhea ```
98
CSF findings bacterial vs viral
Bacterial ↓glucose | Viral normal glucose
99
Causes of UTI
E. coli > klebsiella, proteus, enterococcus
100
UTI abx
IV: - Amp + Genta - Ceftriaxone (no pseudomonas/enterococcus coverage) - Meropenem - Ciprofloxacin PO: - Bactrim - Cephalexin - Nitrofurantoin (not for pyelonephritis) - Amoxicillin-Clavulanate - High SEs, 2nd line
101
Testing for fever without a source
- UA + Urine catheterized culture - CBC if ill-appearing -> left shift = serious bacterial illness - Blood culture if ill-appearing
102
At what age is rapid strep not indicated
Don't do rapid strep checks until age 2
103
Voiding Cystourethrogram purpose
Shows reflux, use if there are recurrent UTIs (>1)
104
Sx of viral meningitis
GI sx since it's usually from enterovirus.
105
Roseola
High fever turning into rash. No therapy needed.
106
Cervical lymphadenopathy ddx
``` Acute infxn Kawasaki Cervical adenitis (infected lymph node) Cat scratch disease TB ```
107
Causes of strawberry tongue
Strep, kawasaki disease
108
Kawasaki disease diagnostic criteria
5d fever + 4 of: - lymphadenopathy - red/swelling extremities - strawberry tongue - conjunctivitis - rash
109
Kawasaki stages
Acute phase: fever subacute: 1-3wks -> sx resolve, aneurysms happen, hand/feet peeling convalescent: 1-2months, still serologic evidence of condition
110
Kawasaki disease complications
Aseptic meningitis Aneurysms Arthritis Gall bladder hydrops
111
Kawasaki disease management
Aspirin high dose, IVIG (to prevent aneurysms) -Cardiology f/u in 2wks + low-dose aspirin 2months Flu/vzv vaccine to prevent reye syndrome
112
Kawasaki lab changes
``` ↑ PLATELETS! ↑ ESR, CRP ↑ AST/ALT ↓ Albumin ↑WBCs Normocytic anemia ```
113
Fever + Rash DDx
``` Adenovirus Kawasaki meningitis measles rocky mountain spotted fever scarlet fever (stre) sjs enterovirus varicella erythema infectiosum (parvovirus B19, slapped cheek, fifth disease) Roseola ```
114
Wheezing DDx
``` Viral bronchitis asthma aspiration gerd tracheomalacia obstruction CF ```
115
Pertussis sx
Catarrhal stage: URI sx -1-2wks Paroxysmal stage: whooping cough -1month Convalescent stage: episodic cough -months
116
Causes of epiglottitis
Hib>>>Staph, strep
117
Diphtheria findings
Gray membrane on throat. | Pharyngitis, fever.
118
Asthma X-ray findings
hyperinflation, atelectasis
119
10 month old child pneumonia causes
Usually vira (adenovirus, rsv, parainfluenza, flu)
120
neonatal pneumonia causes
GBS, e. coli, klebsiella.
121
Viral vs bacterial pneumonia findings
Viral: ↑ WBCs. variable, diffuse/patchy infiltrates, effusion Bacterial: ↑ WBCs w/ ↑neutrophils. Lobar/segmental consolidation
122
Croup cause and treatment
Parainfluenza, treatment is supportive w/ racemic epi
123
When to do daily controller for asthma
If interfering with activity.
124
Purpose of Peak Expiratory Flow (PEF) with asthma
NOT for diagnosis | FOR determining baseline function
125
When to add anti-leukotrienes, antihistamines, flonase etc to asthma treatment
If known environmental causes
126
At what age can you start doing PFTs for kids
Age 5
127
Asthma testing findings
Obstructive findings ↓ FEV1 Scalloped loop
128
Otitis media w/ effusion vs acute otitis media
Otitis media w/ effusion - Just fluid behind eardrum. No other symptoms. Acute otitis media - Bulging +/- redness. Can't just be redness alone.
129
Acute otitis media facts
Usually strep. pneumonia Effusions last for weeks after recovery Management: Amoxicillin, especially if bilateral
130
Persistent otitis media
>3 months of effusion after infection | If hearing loss, will need tubes.
131
Sinusitis course
>10days | URI -> get better -> get worse
132
Pyloric stenosis electrolyte abnormalities
↓ Cl-, ↓Na+, Alkalosis
133
Rehydration therapy for kids
Always start with oral rehydration therapy first. Don't do sporty drinks Do 10-20ml/kg boluses
134
Complications of DKA
Cerebral edema | Potassium loss but maybe be low, normal, or high.
135
DKA sx
Vomiting diuresis (starts at glucose >180) SOB Ab pain
136
DKA management
Admit to hospital Fluids + insulin (.1units/kg/hr) Consult endocrinology DO NOT give HCO3-
137
Limping DDx
``` Legg-calve-perthes (avascular necrosis of epiphysis, subtle chronic pain) Leukemia Osteomyelitis REactive arthitis septic arthtitis Transient synotvitis JIA (>6wks) Slipped epiphysis (Vague hip or knee sx) ```
138
Septic arthritis findings:
``` Fever ↑ ESR ↑WBCs ↑Non weight bearing Dx w/ aspiration: turbid w/ WBCs. ```
139
Transient synovitis of the hip
Post-viral URI syndrome, swelling of tissues around joint | Tx supportive
140
Ibuprofen dosing
10mg/kg Q6-8hrs
141
Age to reach birth weight
2wks
142
Hepatomegaly in newborns suggests
CHF
143
Murmur in ASD
Wide split fixed S2 with systolic murmur
144
Coarctation of aorta abnormalities
HTN in UEs | Decreased femoral pulses
145
Bicuspid aortic valve auscultation findings
Early systolic click
146
Aortic stenosis murmur
Systolic + early diastolic murmur
147
VSD
Won't show up until days-weeks Increased pulmonary blood flow High voltage QRS in V1 and V2
148
CHF treatment in kids
Furosemide Digoxin Enalapril
149
Seizure DDx
``` Toxic ingestion Seizure Syncope Head injury Infxn Tumor intussusception ```

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