Falcon Review Pediatrics 3 Flashcards
A patient presents with a history of sweating while feeding, what pathology does this suggest
Suggestive of cardiac disease
What physical exam findings are suggestive of cardiac disease pediatrics
Poor growth or failure to thrive Abnormal heart rate blood pressure Crackles suggest of left-sided failure Hepatomegaly suggestive of right-sided failure Cyanosis or clubbing Murmur
What is the best diagnostic test for pediatric cardiovascular disorders
Echocardiography
Other studies are helpful such as chest x-ray EKG MRI and cardiac catheterization
Generally speaking define innocent murmurs
Usually soft
Never just diastolic
Never associated with a thrill or a click
Do not require additional work up
Name the four major types of innocent murmurs
Stills
Pulmonary flow murmur
Pulmonary ejection murmur
Venus hum
Describe a stills murmur
3 to 6 years old
Soft vibratory or musical systolic ejection murmur heard at left lower to mid sternal border
Describe a pulmonary flow murmur
0 - 6 months of age
High-pitched blowing systolic murmur at upper left sternal border due to turbulent flow at the origin of the right and left pulmonary arteries
Transmits to back and axilla
Define pulmonary ejection murmur
Similar to pulmonary flow murmur
8 to 14 years of age
Blowing early systolic murmur at upper left sternal border due to increased flow over the pulmonary valve
Define a Venus hum
Not a true murmur
3 to 6 years of age
Continuous (starts in systole and spills into diastole) murmur
Heard in supraclavicular or infraclavicular areas, disappears with compression of jugular vein Institute and supine position
What other concerns should you have for a patient with a congenital heart disease
30% of patients will have other anatomic abnormalities
What are the common causes of cyanosis
Cardiac
Pulmonary
Hematologic
Neurologic
What is the best test isolates the cause of cyanosis
Hyperoxia test
What are the expected results for cardiac disease causing cyanosis on the hyperoxia test
Before oxygenation less than 40 PaO2
after oxygenation less than 50 PaO2.
With complete mixing before you have 50 PaO2 after oxygenation you’ll have less than 150 PaO2
What valves open with systole
Aortic and pulmonic
What valves close with systole
Tricuspid and mitral
What is the most common congenital heart malformation
VSD
Ventricular septal defect
Will a large or small ventricular septal defect have a soft murmur
large
What are the symptoms of a large ventricular septal defect
Congestive heart failure Active precordium Hepatomegaly Crackles BVH or LVH
What is Eisenmenger’s physiology
Initially there is a left to right shunt
Then right ventricular hypertrophy and increased pulmonary vascular resistance
Then a right to left shunt develops
Blood is bypassing lungs and leads to cyanosis
What murmur is highly suggestive of a the ventricular septal defect
Holosystolic murmur (Harsh or soft) at lower left sternal border
What is the prognosis of a ventricular septal defect
30 to 50% of cases will close spontaneously by two years
Surgical closure for failure to close and large defects
What is the normal cardiac to rib cage ratio
Less than 0.5
When does pulmonary vascular resistance reached its nadir in pediatrics
Eight weeks
You will begin to get an increase in left to right shunting
What is the most common type of ASD
Ostium secundum type
Most patients with ASD or asymptomatic until when
Third decade of life
What murmur is suggestive of an atrial septal defect
Systolic ejection murmur and left mid and upper sternal border,
Wide fixed split S2 due to an increased blood in the right atrium and ventricle being pushed through the pulmonic valve
Discuss normal physiology of a split S2
With inspiration the pulmonic valve closes a little later
What many seen on X-ray with an atrial septal defect
An enlarged right atrium in ventricle
What is the biggest risk factor for endocardial cushion defect
Trisomy 21
What murmur is associated with endocardial cushion defect
Holosystolic murmur heard at apex (AV valve insufficiency)
What is a PDA
Patent ductus arteriosus
Failure of closure of ductus resulting in blood flow from aorta to pulmonary artery
Common in prematurity
What symptoms are associated with a large PDA
Pulmonary overload
Wide pulse pressure
Bounding arterial pulses
In infants what may be used to help close the PDA
Indomethacin
prostaglandin inhibitor
What cardiac malformation is highly associated with Turner’s syndrome
Coarctation of the aorta
What murmur is associated with coarctation of aorta
Short systolic murmur at the left upper sternal border with radiation to left back
What chest x-ray findings are associated with coarctation of the aorta
Marked cardiac enlargement
Increased pulmonary vascular markings
Rib notching (from enlarged collaterals)
What congenital malformations are associated with cyanotic heart disease
The five T’s
Truncus arteriosus Transposition of the great arteries Tricuspid atresia Tetrology of Fallot Total anomalous pulmonary venous return
Pulmonary atresia
Large VSD
The last two or associated with cyanotic heart disease after Eisenmenger’s physiology
What’s the most common cause of congenital cyanotic heart disease
Tetralogy of Fallot
What are the findings associated with tetralogy of Fallot
Ventricular septal defect
Pulmonary stenosis
Hypertrophy of right ventricle
Overriding aorta
What determines the cyanotic yet spells associated with Tetralogy of Fallot
Ventricular pressure determines the direction of bloodflow
Acyanotic tetralogy is associated with sufficient pulmonary bloodflow shunting across the VSD is balanced
Paroxysmal cyanosis tet spells occur when systemic resistance drops or pulmonary resistance increases
What will reverse the paroxysmal cyanosis associated with pathology of Fallot
Increasing the left side pressures will reverse the right to left shunt such as bringing the knees to the chest or squatting
What are the murmurs associated with tetralogy of Fallot
VSD over the lower left sternal border
Pulmonic Stenosis
What chest x-ray finding do you expect to have with tetralogy of fallot
Boot shaped heart
What is the transposition of great vessels
Aorta arises from right ventricle, pulmonary artery arises from left ventricle resulting in a parallel circulation
Must be some communication atrial, septal or ductal levels to be compatible with wife
What is the most common cause of extreme cyanosis within the first 24 hours of life
Transposition of the great vessels
Will the cyanosis correct with oxygenation for a transposition of the great vessels
No
What is the treatment for transposition of the great vessels
Prostaglandin to maintain ductus open is life-saving used PGE
Surgical correction is definitive
What do you expect to find with pulmonary atresia on EKG
Tall spiked P waves suggestive of right atrial enlargement, right ventricular hypertrophy
What is the treatment for pulmonary atresia
Maintain ductus open until surgery
What murmur is associated with pulmonary stenosis
Harsh systolic ejection murmur with ejection click at left upper sternal border
What findings suggestive of tricuspid atresia
Cyanosis at birth
Systolic murmur along left sternal border
Single S2
Left axis deviation in the infant
What findings on X-ray are suggestive of a total anomalous pulmonary venous return
The snowman or figure 8 with cardiomegaly
What murmur is associated with total anomalous pulmonary venous return
Systolic murmur at left upper sternal border
S2 fixed and widely split
Increase flow over the pulmonic valve will cause what heart sound
Split S2
What is truncus arteriosus
Single vessel arises from the ventricles supplying systemic/pulmonary/coronary circulation
What the complications of a hypoplastic left heart
Inadequate systemic circulation and pulmonary venous hypertension
Small aorta
What is the most common cause of myocarditis
Viral etiology is most common enterovirus (coxsackie) virus and adenovirus
What are the causes of a dilated cardiomyopathy in infants
Often idiopathic
Maybe associated with neuromuscular disease, drug toxicity, and chemotherapy (including doxorubicin)
What is the diagnostic study for cardiomyopathies
Echocardiogram
What causes acute rheumatic fever
GABHS
1 to 3 weeks after preceding streptococcal infection is commonly in 5 to 15-year-olds
What is required to diagnose acute rheumatic fever
The Jones criteria
- Must have two major criteria or one major and two minor criteria plus evidence of preceding strep infection
What are the Major Jones criteria
Carditis Arthritis Erythema marginatum Chorea Subcutaneous nodules
What are the minor Jones criteria
Fever arthralgia elevated acute phase reactants Prolonged ER Previous rheumatic fever
What is the treatment for acute rheumatic fever
Treat streptococcal infection and monthly penicillin prophylaxis
Salicylates to decrease myocardial inflammation
Steroids for carditis
What is a complication of acute rheumatic fever
Valvular heart disease
What are the most common organisms that cause endocarditis
Staff aureus
Streptococcus Viridans
What are the signs and symptoms of endocarditis
Acute or insidious onset
Persistent fever, chills, arthralgias, new murmur, petechiae
Oslers nodes (painful)
Janeway lesions (painless) splinter hemorrhages
How is endocarditis diagnosed
Echocardiogram
What preventative measures must be taking with endocarditis
Prophylactic antibiotics prior to dental visits
How is hypertension diagnosed in pediatrics
What pressure above 95% for age 3 review measurements
What is the most common cause for pediatric hypertension
Most commonly secondary
Renal is 75 to 80%
What are the risk factors for pediatric arrhythmias
Congenital, acquired or functional heart disease Electrolyte abnormalities Drug toxicity Poisoning Collagen vascular disease
What are some causes of sinus bradycardia pediatrics
Increased vagal tone
hypothyroidism
increased intracranial pressure
anorexia nervosa
Most commonly a normal finding in healthy athletic children
What is the difference between a Mobitz type I and a Mobitz type II heart Block
Type one will have a prolongation of PR then a drop a QRS
Type II will just drop the QRS
What maternal diseases associated with a third degree heart block in infancy
Maternal lupus
What are the causes of sinus tachycardia
Hypovolemia Shock Anemia Fever Sepsis Pulmonary embolism Medications
What do you expect to see on an EKG for supraventricular tachycardia
A runn of three or more premature supraventricular beats a greater than 230 beats permitted
Abnormal or absent P waves
Key association with WPW syndrome
What is WPW syndrome
Anomalous conduction pathway to ventricles bypassing the AV node which leads to premature and prolonged depolarization of ventricles
Predisposes to SVT
On the EKG: shortened PR, Delta wave, wide QRS
What is the treatment for long QT syndrome
Beta blocker
What is apnea of prematurity
Premature infants less than 36 weeks of gestation holding their breath for periods of less than 15 seconds
What is the treatment of apnea prematurity
Theophylline/caffeine as central stimulant
What is the obstructive sleep apnea
Prolonged partial airway obstruction intermittent cessation of breathing disrupting sleep and breathing
What are the pediatric risk factors for obstructive sleep apnea
Adenotonsillar hypertrophy
trisomy 21
Anatomical abnormalities
What is used to diagnose obstructive sleep apnea
Polysomnography
What are the complications of obstructive sleep apnea
Cor pulmonale
Poor growth
Poor school performance
What is cyanotic breath holding
Breath holding spells between the ages of one and three years old usually associated with temper tantrums or angry outbursts
It’s self-limited and very benign
What is Pallad Breath holding
Associated with fright
Patient becomes pale and hold breath
loses consciousness
What is the most commonly aspirated food
Peanuts
Popcorn, grapes, hot dogs are also common
What are the signs and symptoms of a foreign body aspiration
Cough, Strider, shortness of breath, cyanosis
Localized wheezing or new onset wheezing
How will a chest x-ray demonstrate foreign body aspiration
With an expiratory expiratory film. The effected side is the same appearance for both inspiration and expiration
Ball valve mechanism
What is the treatment for foreign body aspiration
Bronchoscopy
What is the pneumothorax
Intrapleural accumulation of air, maybe spontaneous or traumatic
What are the causes of the pneumothorax
CF, congenital lobar emphysema, asthma, pertussis,
Due to excessive cough
What is croup
Laryngotracheobronchitis
What are the most common causes of croup
Parainfluenza is the most common
Adenovirus, RSV, influenza
Most common three months to five years of age
What is the expected x-ray finding for croup
Staple sign
Suggestive of subglottic swelling
What is the treatment for croup
Humidified air in mild cases such as the steam from a shower
For ill children you can use corticosteroids
What is spasmodic croup
episodic and recurrent stridor associated with croup without the associated viral symptoms
What is the most common cause of bacterial tracheitis
Staph aureus
What are the signs and symptoms of bacterial tracheitis
Strider, respiratory distress, toxic appearance, “Brassy” cough, purulent airway secretions
What is epiglottitis
Acute inflammation of the epiglottis
Most commonly H influenza type B, can be strep pneumo-, nontypeable H. influenzae
Most common 2 to 7 years of age
What are the signs and symptoms of epiglottitis
Sudden onset of high fever, dysphasia, drooling, muffled voice, respiratory distress, tripod position, neck hyperextension
What is the main concerns with epiglottitis
The number one priority is securing the airway
TONGUE BLADE EXAM SHOULD NOT BE DONE OR ANY AGITATION PROCEDURE
What is bronchiolitis
Lower respiratory tract infection caused by inflammatory obstruction of the small airways
Usually less than two years of age
RSV is most common
What are the signs and symptoms of bronchiolitis
URI, rhinorrhea, fever, may progress to respiratory distress and poor feeding
Tachypnea, wheezing, crackles, retraction, cyanosis
What is pneumonia
Inflammation of pulmonary tissue associated with consolidation of alveolar spaces
Most commonly viral
What are the signs and symptoms of pneumonia
Fever
Tachypnea
Cough
What are the likely causes of pneumonia in neonates
Gram-negative rods E. coli Lysterria Enterococcus Klebsiella
What are the most likely causes of pneumonia in preschool age children
Strep pneumonia
Staph aureus
Viral is the most common
What is the most likely causes of pneumonia and school-age and up
Mycoplasma/chlamydia
Strep pneumonia
Staph aureus
Viral most common
What will viral pneumonia show on a chest x-ray
Streaky infiltrates, peribronchial coughing
No consolidation
What will a bacterial pneumonia show on a chest x-ray
Lobar consolidation
What is the treatment for mycoplasma pneumonia
Macrolides or quinolones
Most commonly azithromycin
Who is most likely to get chlamydia trachomatis pneumonia
Six weeks to six month olds
What type of cough is associated with chlamydia trachomatis pneumonia
Staccato cough
What is the treatment for chlamydia trachomatis pneumonia
Erythromycin
What is the treatment needed for aspiration pneumonia
Anaerobic coverage such as clindamycin in addition to usual bacterial coverage
What is asthma
Reversible obstructive airway disease affecting small and large airways
What are the components of asthma such as clinical findings
Bronchospasm
Mucus production
Airway inflammation
What are the triggers to asthma
Infection Exercise Cold Allergens Smoke
What can be used for serious acute exacerbations of asthma
Magnesium sulfate
Terbutaline confusion
What is mild intermittent asthma
Daytime symptoms less than two times per week
Nocturnal symptoms less than two times per month
What is mild persistent asthma
Daytime symptoms greater than two times per week but less than one times per day
Nocturnal symptoms greater than two times per month
What is moderate persistent asthma
Daily symptoms
Nocturnal symptoms greater than one time per week
What is the severe persistent asthma
Continuous symptoms
Frequent nocturnal symptoms
What is the treatment for mild intermittent asthma
No daily medication
Short acting bronchodilator as needed
What is the treatment for mild persistent asthma
One daily medication- low dose inhaled corticosteroid
Short acting bronchodilator as needed
What is the treatment for moderate persistent asthma
One daily medication-medium acting inhaled corticosteroid and a long acting bronchodilator
Short acting bronchodilator as needed
What is the mutation associated with cystic fibrosis
Deletion
Most common mutations Delta 508
What is the major problem associated with cystic fibrosis
Abnormality of the chloride transport
Thick mucus and impaired pancreatic secretions
Average age is 30 years
What are the signs and symptoms of cystic fibrosis
Meconium illeus, rectal prolapse, failure to pass meconium in first 24 hours Recurrent respiratory infections Stearrhea Vitamin deficiency A,D,E and K Nasal polyps Diabetes mellitus Delayed sexual development
What is the gold standard to diagnose cystic fibrosis
Sweat chloride test
What is the treatment for cystic fibrosis
- clear secretions
- VEST, Chest PT, inhalation therapy, DNAse - nutrition therapy
- Pancreatic enzyme replacement, Vitamins
3.treat infection aggressively
What is a duodenal atresia
Obstruction resulting from failure to re-canalize the duodenal lumen
What are the risk factors for duodenal atresia
Trisomy 21
What are the signs and symptoms of duodenal atresia
Bilious vomiting, often on the first day of life
Usually no abdominal distention
What’s will an x-ray show for a duodenal atresia
Double bubble
First bubble is air in the stomach
Second bubble is air in proximal duodenum
No air in the rest of the intestines
What is Hirschsprung’s disease
Absence of ganglion cells of bowel wall
What are signs and symptoms of Hirschsprung disease
Failure to pass meconium in 24 hours
Obstruction leads to bowel dilation
What is the treatment for Hirschsprung disease
Surgical resection
What is meconium ileus
Abnormally thick meconium can cause in utero or neonatal blockage
Volvulus and bowel infarction can occur
What is the risk factors for meconium ileus
Cystic fibrosis
90% of patients with meconium ileum have cystic fibrosis
What is appendicitis
Blockage of appendiceal lumen
Most commonly caused by lymphoid hyperplasia, feoclith
What are the causes of gastroesophageal reflux
Inappropriate LES relaxation, hiatal hernia, delayed gastric emptying
Common in all
When is gastroesophageal reflux considered pathological
Infants not gaining weight
Pain and discomfort
Aspiration
What are the signs and symptoms of gastroesophageal reflux
Vomiting, chronic cough, wheezing, apnea, failure to thrive, substernal chest pain
What is the treatment for gastroesophageal reflux
Head elevation
Thickening of seeds (rice, bananas)
Medical managements: H2-blockers, proton pump inhibitors, prokinetic’s
Surgical correction: Nissen fundoplication
What are the risk factors for pyloric stenosis
Firstborn males
What are the signs and symptoms of pyloric stenosis
Nonbileus projectile vomiting usually beginning of 3 to 4 weeks of age
Happy vomiter
What happens with excessive vomiting
Hypokalemic, hypochloremic, metabolic alkalosis
With vomiting you lose hydrogen which leads to alkalosis. Also vomiting chloride which leads to hypochloremia.
Because you are alkolotic, your kidneys begin excreting potassium instead of hydrogen to maintain the hydrogen which leads to hypokalemia
What will ultrasound demonstrates for pyloric stenosis
Thickened elongated pylorus
What is the treatment for pyloric stenosis
REHYDRATION AND ELECTROLYTE CORRECTION FIRST
Then surgical correction
What is colic
Rules of three
- Usually seen three weeks to three months of age
- Crying for greater than three hours per day
- More than three times per week for no other reason
What are the signs and symptoms of small bowel instruction
Bilious vomiting
What are the two classifications of diarrhea
Infectious
Malabsorptive
One of the two mechanisms of diarrhea
Osmotic
- stool volume depends on diet and decreases with fasting
Secretary
- Stool volume is increased and does not increase with diet
What is the most common cause of infectious diarrhea
Viral is most common: rotavirus
Bacterial
Parasitic
What are the features of rotavirus
Watery diarrhea for 7 to 10 days
Maybe associated with vomiting
What is associated with enteropathogenic E. coli
Nurseries and daycare
What are the features of enterotoxigenic E. coli
hemorrhagic colitis
Associated with hemolytic uremic syndrome
What are the features of Yersinia associated diarrhea
Transmitted by pest, contaminated food
Maybe associated with arthritis and rash
Often confused with IBD
Pseudo-appendicitis
What is the onset of time for staph aureus toxin mediated associated diarrhea
Within 12 hours of ingestion
Other food toxins will take closer to 24 hours before symptoms manifest
What is the treatment for diarrhea
Ensure adequate hydration
What is the most common cause of constipation
Functional (voluntary withholding)
Other causes include: meconium ileus (CF) Hirschsprung disease, botulism, hypothyroidism
What is encopresis
Fecal incontinence after age 4 years
What are the signs and symptoms of encopresis
Leakage of loose stool around obstruction
What is hematemesis
Blood stained vomitus
Usually indicates bleeding proximal to the ligament of Treitz
(Dividing line between duoden and jejunum)
What is allergic proctocolitis
Streaks of blood in stool
Typically not ill appearing with history of milk use or exposure
Hematochezia in infancy one day to three months of age is typical
What is the treatment for allergic proctocolitis
Partially hydrolyzed formula
Hypoallergenic formula
What is Meckel’s diverticulum
Known as the happy bleeder
Most common congenital G.I. anomaly
Vestigial remnant of the omphalomesenteric
Disease of 2’s
2% infants, two years, 2 cm, 2 feet from ileocecal valve
What are the signs and symptoms of Meckel’s diverticulum
Painless rectal bleeding
What will hard stools induce
Anal fissures
What is an intussusception
Portion of G.I. tract telescopes into portion Distal to it; most are ileocolic
6-24 months
Associated with lympoid hyperplasia (peyer’s patches), Meckel diverticulum
What are the signs and symptoms of intussusception
Acute onset of cramping intermittent pain, lethargic, currant jelly stool, soft sausage shaped mass on rectal exam
What is both diagnostic and therapeutic for intussusception
Barium enema
Surgical intervention needed if failed reduction with enema twice
What are the signs and symptoms of Crohn’s
Weight loss Fever Abdominal pain Growth failure Diarrhea Perianal disease or mouth ulcers
What does a colonoscopy and biopsy demonstrate for Crohn’s disease
Skip lesions
Transmural inflammation
Noncaseating granuloma’s
What is the treatment for Crohn’s disease
Steroids
Immunosuppression
What are the signs and symptoms of ulcerative colitis
Involves only the colon
Bloody diarrhea with mucus
Abdominal pain symptoms
must be present for at least 3 to 4 weeks to make a diagnosis of exclusion
What is the complication of ulcerative colitis
colon cancer
How is a obesity determined in pediatrics
BMI greater than 95% for age/sex
BMI greater than 30 in adolescence
What are signs and symptoms of obesity in pediatrics
Striate
Pseudogynecomastia
Early puberty
What are the causes of obesity in pediatrics
Endocrine (cushion, hypothyroidism, Prader-Willi)
Genetic (turner)
Most commonly lifestyle
What is celiac disease
Gluten sensitive enteropathy
Develop when gluten containing foods (wheat, rye, barley) introduced 6 to 12 months, depending on preference leading to failure to thrive
What is the pathophysiology of celiac disease
Intraepithelial lymphocytes in villi causing villous blunting
Associated with dermatitis herpetiformis
What is the dermatitis herpetiformis
Erythematous vesicles distributed symmetrically over elbows and knees
What are the rest factors for celiac disease
Down syndrome
Type I diabetes mellitus
Autoimmune disease
What testing is available for celiac disease
Tissue transglutiminase
Anti-enodmysial antibody
Must obtain an IgA level at the same time to prevent a false negative
What’s will biopsy demonstrate for celiac disease
Villus blunting and second biopsy following gluten-free diet with normalization of architecture
What is failure to thrive
Failure to gain weight or deceleration of weight growth
Less than 10 percentile
Crosses two or more percentile marks for growth curve
What are the causes for failure to thrive
Nonorganic (deprivation, neglect, abuse) is the most common cause
Malnutrition Mal absorption Allergies Immune deficiency states Chronic disease
What is the first thing to notice with caloric deprivation failure to thrive
Weight
What is affected more for failure to thrive due to hyporthyroidism and growth hormone deficiency
Height
What is constitutional growth delay
The child will follow the growth curves and will ultimately reach adulthood with a delayed growth spurt
What is familial short stature
Adult height will be below the growth curve
Normal curve throughout, just below the normal percentages
How do you tell the difference between a constitutional growth delay and familial short stature
By using a bone age
- If bone age is less than chronological age then the diagnosis constitutional growth delay
- If bone age equals chronological age, then diagnosis is from familial short stature
What is the symptoms of vitamin A deficiency
Ocular lesions (xerosis)
Night blindness
Dry skin
What are the symptoms of a thiamine (B1) sufficiency
Beriberi neuritis
Heart failure
Encephalopathy
What are the symptoms of the niacin deficiency
Pellagra
Diarrhea
Dermatitis,
Dementia
The symptoms of a pyridoxine (B6) deficiency
Seizures
Neuritis
Dermatitis
Anemia
What are the symptoms of a vitamin C deficiency
Scurvy
Pseudoparalysis
Mucous membrane hemorrhages
What are the symptoms of vitamin D deficiency
Rickets
Craniotabes
Rachitic rosary
Bowlegs tetany
What are the symptoms of vitamin E deficiency
Creatinuria
Muscle weakness
Anemia
What are the symptoms of vitamin K deficiency
Hyporprothrombinemia
Bleeding
What are the symptoms are riboflavin (B2) deficiency
Seborrheic dermatitis Anemia chelitis/bursitis/stomatitis Photophobia Sore throat edmatous oropharyngeal mucosa
What is the problem with adolescent pregnancy
Higher rates of illness and death from both mother and infant
What is pelvic inflammatory disease
Ascending spread of organisms from lower genital tract to cervix, endometrium and fallopian tubes
What is the most common calls of pelvic inflammatory disease
Chlamydia and gonorrhea
What are the signs and symptoms of pelvic inflammatory disease
Abdominal pain, cervical motion tenderness, adnexal tenderness;
May have fever, leukocytosis
What is the treatment for pelvic inflammatory disease
Gonorrhea: IM ceftriaxone
Chlamydia: 14 days of doxycycline
What is the reason we treat for pelvic inflammatory disease
To prevent complications such as Tubo-ovarian abscess Increase risk for ectopic pregnancy in the future Decreased fertility Fitzhugh Curtis syndrome
What is Fitzhugh Curtis syndrome
Perihepatitis
PID plus right upper quadrant pain in transaminase elevation
What are the signs and symptoms of gonorrhea
Purulent vaginal discharge, dysuria, abdominal pain, arthritis (large joints)
What is the treatment for gonorrhea
Cefiximine for anything less than PID
Ceftriaxone for PID
Treat concurrently for chlamydia
Emperic testing for comorbid STDs
What complication is associated with gonorrhea
Fitzhugh Curtis-perihepatitis
What is chlamydia
Intracellular obligate parasites
Most common STD
What is gonorrhea
Gram-negative intracellular diplococci
What are the signs and symptoms of chlamydia
They are often asymptomatic; use a routine screen
Urethritis, cervicitis, PID
What is the treatment for chlamydia
Azithromycin or seven days doxycycline for urethritis/cervicitis
14 days doxycycline for PID
Legally how are adolescents affected by reproductive health
There considers emancipated minors
Herpes simplex virus type I most often affects what region
Make calls genital disease but usually oral and CNS infections
Herpes simplex virus type II soft effects what region
More common causes genital infection
Where the signs and symptoms of herpes
Fever, regional adenopathy, dysuria, painful vesicles and ulcers
How’s herpes diagnosed
Most often clinical but may use a tzanck smear
What is the treatment for herpes
Acyclovir for outbreaks-early in the course (within a day)
If genital disease, evaluate for other STDs
What is Trichomonas vaginalis
Mobile flagellated protozoan
What are the signs and symptoms of trichomonas vaginalis
Malodorous, frothy, yellow-green discharge and vaginal itching
How is trichomonas vainalis diagnosed, what technique
What prep to look for leukocytes and Mobile trichomonads
What is the treatment for trichomonas vaginalis
Metronidazole
What causes bacterial vaginosis
Gardnerella vaginalis,
Mycoplasma hominis
What are the signs and symptoms of bacterial vaginosis
Send, white, foul-smelling discharge that smells “fishy” when mixed with KOH
Vaginal pH > 4.5
What will a wet prep demonstrate for bacterial vaginosis
Clue cells
What is the treatment for bacterial vaginosis
Metronidazole
What are the signs and symptoms of vaginal candidiasis
Thick, white, vaginal discharge with vaginal itching and burning
What will a wet prep demonstrate for vaginal candidiasis
KOH prep to look for yeast and pseudohyphae
What are the causes for amenorrhea in pediatrics
Primary: chromosomal (turner syndrome) or congenital (imperforate hymen)
Secondary: malnutrition (anorexia), endocrine disorders/hypothalamic
What are the steps to diagnose amenorrhea
Evaluate for pregnancy and presents/absence of virilization
Progesterone challenge test: withdrawal bleeding will occur with normal endometrium tract presents
Check FSH, LH (elevated level suggest primary gonadal failure), TSH and prolactin
What are the causes of dysmenorrhea
Primary: absence of pelvic condition and related to prostaglandin production
Secondary: structural abnormality, endometriosis
What is the treatment for dysmenorrhea
Consider NSAIDs, OCP
What is polycystic ovarian syndrome
Excessive levels of LH resulting and increased ovarian androgen production
Associated with peripheral insulin resistance
One of the signs and symptoms of polycystic ovarian syndrome
Multicystic ovaries, hirsutism, menstrual irregularities
What is the treatment for polycystic ovarian syndrome
Consider OCP’s
