CLIPP 11 Flashcards
main reason we tx strep throat (group a beta hemolytic strep typically)
to avoid rheumatic fever
rapid strep antigen test has __sensitiviyt and __specificty
variable, high
when to do strep culture
to confirm results of negative rapid strep
Appropriate antibiotics started within __ days from the start of the acute illness will prevent acute rheumatic fever.
9
Rx of choice in GAS infxn
PCN tho the liquid form tastes bad so amox is often used instead - ideally wait for documented +test before starting abx
3 of the many things that can present as irritablity
fatigue, meningitis, increased ICP/intracranial irritation
noraml 5yo HR
80-100
JIA can be broken into these different categories
polyarticular, pauci/oligoarticular, systemic-onset (stills dz)
Kawasaki dz is a form of __ w these sx
vasculiis.
non purulent conjunctiva, rash on body, arthraglia, strawberry tongue, hands and feet skin desquaamating . fever >5days. swelling and erythema of extremities.
one example of fever for >= 5 d
kawaki
osteomylitis / septic joint
low grade temp, pain walking if in lower extremities
rmsf
rash on palsm/soles/wrists that spreads inwards
rash on palms/soles
Kawasaki disease, enteroviruses, syphilis
scarlet fever
Fever (generally < 5 days) (whereas MORE duration in kawsaki)!
A diffuse, erythematous, finely papular rash (described as having a “sandpaper” texture) is pathognomonic
Rash often begins at neck, axillae, and groin and then spreads over trunk and extremities, typically resolving within four or five days
SJS
severe itchy rash (EM), fever <7d, mucosal changes, conjunctivitis. affects mucucutaneous things
viral syn/ antibiotisc
fever 3-5 d, non desecript NONPAINFUL rash that can start plams/soles,
does enterovirus rash hurt to walk
no
leggs calves pertches
ccurs when blood supply is temporarily interrupted to the ball part (femoral head) of the hip joint. Without sufficient blood flow, the bone begins to die — so it breaks more easily and heals poorly. would see limp but no rash, fever or conjunctivitis
conjuncitviits fever and rash
could mean measles or kawasaki. measles unlikely in fully immunzated kid
can sinusitis cause rash?
nope
7 rashes assoc w/ fever and their distinguishing signs
enterovirus: often maculopapular, w high fever often, and often on palms/soles
erythema infectiousom: 5th dz/parvo, low fever–>rash 7-10d later w slapped cheek look and lacey and reticular on extremities. can cause arthralgia or aplastic anemia
measles: fever, cough, coryza, conjunctivitis–>rash at top of body–>spreads down to toes
meiningococcemia: due to NM. abrupt onset often w meningitis sx. can become purpuric.
roseola: fever–>fever goes–>rash on arms.neck often in kidsextremities/head. lesions of various stages. mild fever. dz is self limited, around a week.
koplick spots
in measles, erythematous spots w/ bluewhite centers in buccal mucosa
kawasaki mneuonic
CRASH and Burn
Conjunctivitis- non exudative, bilateral injection. >90%
Rash- anything….. but not vesicular and not bulla. >90%
Adenopathy > 1.5cm. typically cervical and unilateral. 90%
Hand- Swelling or Erythema or hands feet. progresses to peeling but this is late. >90%
and Burn… 5 days of daily fevers.
complications: coronary aneurisms.
Treatment is high dose aspirin(to prevent clots) and IVIG(reduces aneurisms from 20%-> 3%).
is generalized LAD w or w/o splenomegaly more or less concerning than isolated LAD
more
infectious and non infectious causes of generalized LAD
histo, myco (local or isolated), toxo, hiv, measles, mono
leuk, lympho, metastatic neuro, rhabdo, histio
causes of unilateral cervical LAD
Bacterial cervical adenitis
Cat scratch disease
Reactive node from an oral inflammatory or infectious process
Kawasaki disease
Mycobacterial infection (both tuberculosis and atypical mycobacteria) can present with unilateral cervical lymphadenopathy, but the course of this illness is more indolent than Jason’s
bacterial cervical adenitis
in younger children (1-5yo) after URI. often strep pyo or staph aureus. can have high fevers and look toxic and can get abscesses/celutlis
if kid has myobacterial lymphadenitis, most likely ___ in 2-4 yo children and __ in kids>12yo
non tuberculoous, tuberculousis
in PPD test, what do we measure? in normal people, what is a +result?
measure diameter NOT redness of induction. >=15mm
strawberry tongue w/ prominent pappilae
streptococcal pharyngitis (C), Kawasaki disease (E), and toxic shock syndrome (F).
kawasaki cbc
high wbc, normocytic normochromic anemia, normal mcv, normal plt until second week of dz where it rises
kawasaki lft
elevated, can have low albumin
elevated lfts in these two conditions w fever and rash, among others
sjs, kawasaki
kawasaki esr
neg esr would strongly argue against this
UA kawasaki
sterile pyruia - clea catch urine will show wbc while a cath urine won’t since the wbc are from the urethra. sterile pyuria means +UA but -UC. leak esterase not as specific as #wbc.
kawasaki dx criteria
In addition to high fever for at least five days, four of the following five criteria are needed for a diagnosis of Kawasaki disease:
Changes in oral mucosa (A) Extremity changes (redness/swelling) (B) Unilateral cervical lymphadenopathy (C) Rash (D) Conjunctivitis (E)
The one least likely to be present is cervical adenopathy.
biggest complication in kawasaki
coronary artery aneurysm - do echo at acute phase to look for them and to make baseline, often the aneurysms are there by end of week 4.
general tx approach of kawasaki
echo, ekg, asrpiin (high dose 80-100mg/kg/day in 4 doses and then low dose after defervesence of 3-5mg/kg/day once for anti platelet effect and discontinue after 6-8 weeks if no aneurysm seen, but continue if seen aneurysm for anti platelet nature), iviv (helped decrease coronary aneurysm incidence and is given in single dose of 2g/kg over 10-12h)
aspirin in kawasaki does..
not help aneurysm dvpt control. helps fever and anti platelet
med to avoid in kawasaki and why
ibuprofen - antgaonizes aspirins anti platelet effect
f/u for kawasaki (4 things)
- w/ cardiology in 1-2 weeks bc if they are gonna have an aneurysm, its often within 4 weeks of acute illness
- 6-8w of low aspirin so check for GI bleeds, Reyes and get flu shot
- can have NSAIDS if arhtraglias are bad
- monitor for fever
issue w/ aspirin in kids
reyes syndrome (multi organ failure) if get certain viruses while on aspirin. thus docs should make sure kid has flu shot /chiekn pox shot etc before staring aspirin .
cocksackie A is __
enterovirus
is there dysuria in kawasaki?
no - there is pyuria but dsyuria is related to UTI
systemic onset JIA
also known as Still’s disease, is a subset of JIA describing patients with intermittent rash, fever and arthritis. While our patient does present with rash and fever, as well as refusal to walk (potentially a sign of arthritis), systemic onset JIA tends to present with a history of spiking fevers and “salmon” rash occurring when the child is febrile, and disappearing as the fever fades.
two key modalities for JIA patients to f/u w.
optho (uveirits) and PT
one key modality for SJS pt to f/u w/
optho
