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MI Differential Diagnosis & Med Screening > GULICK: Medical Screening PEDS & ADOLESCENCE > Flashcards

GULICK: Medical Screening PEDS & ADOLESCENCE Flashcards

1
Q

VITAL SIGNS ARE ______

A

VITAL!!!!

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2
Q

Vital Signs Chart

*NOTICE TRENDS!!!!

A
  • HR→ Starts high, DECs as we get OLDER
  • RR→ Starts high, DEC as we get OLDER
  • SBP→ Starts low, INC as we get OLDER
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3
Q

Vitals Signs chart

Broken down into %’s bw SBP and DBP

A
  • Things to note:
    • 95th percentile== concerning lvl
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4
Q

Things to note w/ Childhood Dis’s

A
  • HOW/WHEN present?
  • Contagious in nature?
  • Pattern recognition***
  • When should you be concerned?
  • Hygiene/cleanliness***
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5
Q

Childhood Diseases:

Common threads for these diseases:

A
  • Rubella- RNA Virus
  • Roseola
  • Chicken Pox- DNA Virus
  • Measles (Rubeloa)- RNA Virus
  • Scarlet Fever
  • Mumps- RNA Virus
  • Conjuctivitis
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6
Q

Childhood Diseases:

Rubella

Contagious Time + S/S:

A
  • Contagious→ MOST contagious 7d before to 7d after rash
  • S/S: cold/flu sx’s
    • Rash→ face/trunk, spreads to extremities
    • MILD fever, lymph node adenopathy, CCC (cough, congestion, conjuctivitis)
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7
Q

Childhood Diseases:

Roseola (rosy red rash)

Contagious & S/S

A
  • Contagious→ via DIRECT contact, cough, sneeze
  • S/S: cold/flu sx’s
    • SZ w/ high fever
    • Fever x3-4d f/b rash**
    • Maculopapular rash on trunk, spreads to extremities
    • Red bumps may turn white after touched
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8
Q

Childhood Diseases:

Chickenpox (Varicella*)

Contagious & S/S

A
  • Contagious→ Incubation period= 11-21d, contagious via droplets→ cough, sneeze, direct contact w/ blisters
  • S/S: cold/flu sx’s*
    • 3 stage sx’s: 1. macule 2. vesicle 3. granular scab
    • Skin lesions start on trunk, spread to limbs, buccal mucosa, scalp, axilla, UR tract, conjuctiva
    • Itch/body aches
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9
Q

Childhood Diseases:

Measles (Rubeola)

Contagious & S/S:

A
  • Contagious: Incubation time= 10-21d, contagious via airborne droplets, fluids in blisters from 1-2d before blisters
  • S/S:
    • 1st signs=> Fever >100*, sore throat, runny nose, cough
    • W/in few days→ bright red blotchy rash on face/neck, spreads to limbs; rash fades 3-5d
    • *Koplik’s Spot→ small, red spots w/ bluish white specks in center
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10
Q

If you see Koplik’s Spots….. Think

A

MEASLES (RUBELOA)****

Small, red spots w/ bluish white specks in center ***

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11
Q

If you see “Sandpaper Rash” think……

A

Scarlet Fever*****

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12
Q

Childhood Diseases:

Scarlet Fever

Contagious & S/S:

A
  • Contagious→ Freq evolves from initial illness of strep throat** & spreads thru airborne droplets; contagious until antibx taken for 24hrs
    • Peak prev=> 4-8yo
  • S/S:
    • HIGH fever x1-2d f/b rash
    • Pink skin rash on neck, chest, axilla, groin, thighs
    • ***Rash feels like sandpaper
    • Nausea, vom, Strawberry tongue
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13
Q

Childhood Diseases:

Mumps

Contagious & S/S:

A
  • Contagious→ FROM 6d prior to & UP TO 2wks after gland swelling; Direct contact OR airborne droplets
  • S/S:
    • Enlarged salivary glands*
    • HA, mm aches, fever, diff swallowing (2* swelled salivary glands), vom
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14
Q

Conjuctivitis aka

A

Pink Eye!!!!

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15
Q

Conjuctivitis (Pink Eye)

Things to NOTE/REMEMBER:

A

NO RASH

2* to ALL the other childhood diseases****

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16
Q

Childhood Dis’s

Conjuctivitis (Pink Eye)

Contagious & S/S:

A
  • Contagious→ via DIRECT CONTACT
  • S/S:
    • MOST COMMON== Eye irritation (feels like piece of sand in eye)*
    • Red/swelled eye/eyelid
    • Crust of discharge→ eyelids stuck together in morning
    • Photosensitivity & itching
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17
Q

The following childhood disease is a DNA virus:

A

Chickenpox (Varicella)

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18
Q

The following childhood disease(s) are RNA Viruses:

A

Rubella, Measles (Rubeloa), Mumps

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19
Q

Systems Review: Musculoskeletal

Marfan Syndrome

A
  • Disproportionate arms, legs, fingers
  • Kyphoscoliosis
  • Defective heart valves*, Dissecting aortic aneurysm
  • Thumb sign (Steinberg Sign)******
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20
Q

Systems Review: Musculoskeletal

Ehlers-Danlos Syndrome think…..

A

Connective tissue disorder

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21
Q

Systems Review: Musculoskeletal

Ehlers-Danlos Syndrome

A

Connective tissue disorder

  • Effects Type I, II, V collage
  • Beighton Scale of Joint Hypermobility (9pt scale)
  • Easily damaged blood vessels
  • Hyperelastic skin→ “Skin Sign”
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22
Q

Beighton Scale of Joint Hypermobility

Used for what disease?

A

Ehlers-Danlos!!!

  • HIGH lvl laxity→ Score of 7-9
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23
Q

Hess Test think…..

A

Vascular Ehlers-Danlos !!!!!

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24
Q

Systems Review: Musculoskeletal

Ehlers-Danlos

Hess Test

A

Vasular Ehlers-Danlos

  • How to: inflate BP cuff on upper arm to pressure bw SBP & DPB; maint. x5mins
  • Result→ >10 petechiae is an ABNORMAL RESPONSE indicating capillary fragility
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25
Q

Systems Review: Musculoskeletal

Ehlers-Danlos Syndrome

GUIDELINES TO FOLLOW GIVEN NATURE OF DISEASE AND BC ITS A CONNECTIVE TISSUE DISORDER!!!!

A

NO stretching

Stabilization****

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26
Q

Systems Review: Musculoskeletal

Congenital Hip Dysplasia aka Developmental Dysplasia of the Hip (DDH)

A

see pics

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27
Q

Systems Review: Musculoskeletal

Congenital Hip Dysplasia (DDH)

Pathogenesis

A
  • Start→ in Utero, subluxation may occur that results in flattened posteromedial femoral head, anteversion, & shallow acetabulum
  • Prolonged and repeated dislocation→ leads to greater incidence of hip OA***
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28
Q

MOST COMMON HIP ABNORMALITY IN NEWBORNS

A

Congenital Hip Dysplasia

DDH

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29
Q

Baby hips by #s

A
  • MOST COMMON ABNORMALITY in NEWBORNS→ DDH
  • 1/10 have hip instab.
  • 1 in 500 have dislocations
  • ~20-30% ID after 3mos of age
  • NOTE: Harder to manage AFTER walking***
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30
Q

Systems Review: Musculoskeletal

Congenital Hip Dysplasia (DDH)

Clinical Presentation

A
  • AFTER 6wks→ hip may not reduce
  • Asymmetry→ Thighs or Gluteal folds
  • LIMITS in→ Hip ABD
  • Unequal femoral length
    • Uneven Knees==> Galeazzi’s Sign
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31
Q

Systems Review: Musculoskeletal

Congenital Hip Dysplasia (DDH)

Clinical Presentation: talk about Gait Pattern:

A
  • Abnormal Gait Pattern:
    • Toe-walking, IN-toeing or OUT-toeing
  • NOTE: (+) Ortolani and Barlow test present
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32
Q

Systems Review: Musculoskeletal

Congenital Hip Dysplasia (DDH)

2 tests that we perform

A
  1. Ortoloani test→ OUT to IN
  2. Barlow test→ (dislocate)
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33
Q

DDH/Congenital Hip Dysplasia

Ortolani Test

*remember OUT→IN

A

OUT→ IN

Relocating femoral head INTO acetabulum

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34
Q

DDH/Congenital Hip Dysplasia

BarLOW (disLOcate) Test

A

DisLOcate

Subluxing femoral head

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35
Q

Systems Review: Musculoskeletal

DDH/Congenital Hip Dysplasia

INTERVENTION

A
  • Reduce hip
  • Pavlik Harness→ Flexion + free ABD: effective reduction 91.5% cases
    • 3-6mos continuous wear
    • If ineffective→ skin traction, closed reduction, spica cast maybe
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36
Q

*Cardinal Rule for Child w/ Knee pain:

A

ALWAYS EVALUATE THE HIP!!!!!

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37
Q

AVN of hip OR

Legg-Calve-Perthes Disease

WHO?

A

Boys 3-13 (avg 5-7yo)

see pics

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38
Q

Systems Review: Musculoskeletal

AVN/Legg-Calve-Perthes Disease

S/S:

A
  • PAIN→ groin, buttock, prox. thigh
    • Exacerbated by WB
  • DECd hip IR + ABD ROM
  • Antalgic gait
  • Radiographs:
    • coxa magna (broad head/neck of femur)
    • demineralization
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39
Q

Slipped Capital Femoral Epiphysis aka SCFE

think…..

A

Cone slips out from ice cream *****

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40
Q

MOST COMMON ABNORMALITY IN NEWBORNS

A

DDH

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41
Q

MOST COMMON DISORDER OF ADOLESCENT HIP

A

SCFE

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42
Q

Systems Review: Musculoskeletal

SCFE

Epidemiology & Pathogen.

A

MOST COMMON disorder of Adolescent hip***

  • Girls- 12yo Boys- 14yo
  • Displacement of femoral neck FROM the capital femoral epiphysis (cone separating from ice cream*)
  • Coxa Valga of developing femur==> Shear forces
  • Injury from innocuous causes
  • Neck migrates UP & OUT as head remains in acetabulum
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43
Q

What should you ALWAYS REMEMBER ABOUT SCFE AND INITIAL SYMPTOM?????

A

45% have KNEE or LOWER THIGH PAIN as Initial Symptom***

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44
Q

45% have KNEE or LOWER THIGH PAIN as Initial Symptom*** w/ this abnormality

A

SCFE****

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45
Q

Systems Review: Musculoskeletal

SCFE

Dx & Intervention

A

*45% have knee or lower thigh pain as initial sx

  • Radiographs, phys exam, sx’s used to determine if hip is stable or unstable
  • Intervention→ relief of sx’s, containment of femoral head, restoring ROM
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46
Q

Systems Review: Musculoskeletal

Transient Hip Synovitis aka ________ aka ______

A

Toxic Synovitis

Phantom hip disease

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47
Q

Systems Review: Musculoskeletal

Transient Hip Synovitis aka Toxic Synovitis aka Phantom Hip Dis.

A
  • Acute pain W/OUT any assod MSK or constitutional sx’s
  • Maaaaaybe limp
  • Child afebrile (no fever)
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48
Q

Systems Review: Musculoskeletal

Transient Synovitis aka Toxic Synovitis aka Phantom Hip Dis.

Dx Tests

A
  • Normal or mildly elevated CBC, ESR, & C-Reactive PRO lvls
  • X-ray→ NORMAL
  • Hip US→ maybe effusion
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49
Q

Transient Synovitis

Tx?

A

Self-limiting w/ oral analgesics

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50
Q

Transient Synovitis

THIS dx has similar EARLY presentation BUT w/ addition of fever

A

Septic Arthritis

  • Addition of fever
  • Reqs emergent surgical drainage & IV antibx
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51
Q

MOST COMMON TYPE OF SALTER-HARRIS Fx

A

Type 2

Through growth plate AND metaphysis

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52
Q

Salter-Harris Epiphyseal Fx Classification

S.A.L.T.R

A
  • S: Separated
  • A: Above
  • L: Lower
  • T: Through
  • R: Rammed
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53
Q

Multiple Stress Fx’s

3 Reasons:

A
  1. Training prob
  2. Nutrition prob
  3. Eating disorder
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54
Q

Stress Fx’s

A
  • Tiny cracks in the bone due to repetitive force
  • Common in athletes & military recruits
  • LE MORE COMMON***** (MOST to LEAST)
    • Tibia
    • Navicular
    • Fibula
    • Femur
    • Pelvis
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55
Q

70% Stress Fx’s due to:

A

Metabolic abnormalities OR Nutritional deficits

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56
Q

Stress Fx

Risk Factors:

A
  • >10 alcoholic bevs/wk
  • LOW lvl Vitamin-D
  • Smoking
  • >25 miles/wk
  • Sudden INC in activity and/or limtd rest
  • Female Triad=== eating disorder, amenorrhea, osteoporosis***
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57
Q

Stress Fx Risk

Female Triad:

A

Eating disorder→ Amenorrhea→ Osteoporosis

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58
Q

Stress Fx’s

S/S

A
  • Swelling INC w/ activity, Pain INC w/ activity
  • Point tenderness
  • Earlier onset of pain w/ ea successive workout
  • Continued pain @ rest as damage progresses
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59
Q

Stress Fx’s and X-ray

A

Stress Fx are NOT EVIDENCED on X-ray for 10-14 days***

  • NOTE: bone callus formation
  • Long after they’ve started to heal, THEN visible on X-ray
  • NWB activities***
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60
Q

Stress Fx

Plain films

A

(-) 30-70% of time

GREAT screening tool (high Sn)

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61
Q

Stress Fx’s

Clinical Techniques

A
  • US
  • Vibratory Pain:
    • Sn= 75%
    • Sp= 67%
  • Tuning Fork
    • 128Hz, 256Hz***, 512Hz
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62
Q

Tuning Fork for Stress Fx

Hz to use?

A

256 Hz

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63
Q

Stress Fx’s

Bone Scan

A

(+) w/in 1-8days

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64
Q

Stress Fx

MRI

A

Sn=90% good screening tool

HIGH cost tho

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65
Q

Ottawa Ankle & Foot Rules

Great SCREENING tool

A

*Tell you whether radiograph needed!!

  • Adults:
    • Sn= 95-100%*** (Screening tool)
    • Sp= 16%
  • Children:
    • Sn= 83-100%**** (Screening tool)
    • Sp= 21-50%
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66
Q

Osteoporosis

2 Notes

A
  1. Starts as a child*
  2. We want to START w/ GOOD bone stock***
  3. High calcium foods, exercise regularly, no smoking @ young age
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67
Q

Forces on Humerus during throwing

Richard Souza, 2014

A

Throwing side thicker

Opp arm loses bone stock***

68
Q

Fitness & Bone Strength & Structure in 3-5yo Children

A

Fit vs Unfit Group vs Strong

  • Fit group→ higher vals vs unfit an strong for total & cortical bone mineral content, cortical area, and polar strength strain index
    • higher cortical thickness vs unfit
69
Q

Systems Review: Musculoskeletal

Hernia

3 types:

A
  1. Femoral
  2. Inguinal
  3. Sports (Athletic Pubalgia*)
70
Q

Hernia

High risk sports:

A

Soccer, Football/Rugby, Ice hockey

*constant cut and load

71
Q

Systems Review: Musculoskeletal

Sports Hernia (Athletic Pubalgia)

Clinical Presentation:

A
  • Dx of exclusion: R/O other causes of pain FIRST!
    • Genitourinary, Intra-abdom, Gynecological, Hip/lumbar→ strains and sprains
  • MOST SPECIFIC SIGN→ tenderness over medial inguinal floor, or Hesselbach’s Triangle***
  • MOST SPECIFIC FINDING→ Pain in the inguinal floor w/ resisted sit-up
72
Q

Tug of War is a test for _________

A

Sports Hernia

Athletic Pubalgia

73
Q

Tug of War

Athletic Pubalgia (sports hernia)

More females now

What muscles ?

A

Rectus abdominus (ecc.) & Adductor muscle (iso.)

  • Test:
    • Standing w/ ball bw knees
    • Press post hips against tx table
    • Extend trunk (ecc. rectus)
    • (+) Test= PAIN
74
Q

Systems Review: Musculoskeletal

Sinding-Larsen-Johansson Syndrome (SLJ) vs. Osgood Schlatter Syndrome (OSS)

A
  • NORTH SIDE→ Sinding-Larsen-Johansson Syndrome (SLJ)
  • SOUTH SIDE→ Osgood Schlatter Syndrome (OSS)- think 2 S’s so this is South Side

NOTE: BOTH UNDER patella ****

75
Q

Systems Review: Musculoskeletal

Patello-Femoral Tracking

ACL Prediction

Dynamic Jump Test

A

Sn= 67-87%

Sp= 60-72%

76
Q

Hip Mechanics w/ PFP (knee)

A
  • Females: 21 PFP vs 20 no pain
    • PFP= INC hip IR
    • PFP= 14% LESS hip ABD torque
    • PFP= 17% LESS hip EXT torque
    • PFP= INC glute max recruitment needed to stabilize hip***
77
Q

Dynamic Q-Angle

Descending Stairs

A

Control= 24* (valgus)

PFS= 39* (valgus)

78
Q

Atrophy of the quads is NOT isolated to vastus medialis oblique (VMO) in indivs w/ PFP***

A
  • PFP vs control for thickness of vastus medialis, intermedius, lateralis, & rectus femoris
  • Atrophy of ALL PORTIONS OF QUADS was present in PFP group vs control w/ no patho
  • *********
79
Q

HIP is the answer

w/ PFP

A
  • Systemic review concluded studies including Hip ER & ABD’s w/ quad strengthening had LOWER pain values & better functioning than quad strengthening alone
80
Q

Strength Ratios for Hip ABD and Hip ER

A
  • Hip ABD= 30deg of ABD & HHD 10cm proximal to lateral femoral condyle
  • Hip ER= sitting 90/90, HHD just proximal to medial malleolus
81
Q

Take Home Message

Patellar tracking or ACL problem

A
  • Clinical cutoff to define HIGH RISK:
    • Hip ABD <35.4% of bw
    • Hip ER <20.3% of bw
82
Q

Horse is Dead!!!!

A
  • STOP trying to strengthen VMO→ VMO weakness is the effect NOT the cause of the problem
  • FORGET Static Q-angle! Look @ dynamic Q-angle (stairs, jump)
83
Q

Systems Review: Neuromuscular

Bacterial Meningitis

*MEDICAL EMERGENCY IN CHILDREN!!!!

Contagious & S/S

A
  • Contagious→ HIGHLY contagious via droplets saliva
  • S/S:
    • HA-“WORST of my life!!!”
    • fever/light sensitive
    • Lethargy (hypOtonia) + stiff neck
    • Poor feeding; vom; chills
    • Resp distress, apnea
    • *Paradoxic irritability→ Do not want to be moved or touched; what orig. soothes them makes it worse
    • Rash, SZ 30-40%
84
Q

Paradoxic Irritability think….

A

PEDS→ Bacterial Meningitis

Do not want to be touched or moved. What orig soothes them makes it worse

85
Q

Bacterial Meningitis

Distinguishing bw Bacterial vs. Viral

A
  • Bacterial→ gets into bloodstream via cough/sneeze, kiss, foods, trauma
  • Viral→ LESS severe; enters via GI or Resp.
86
Q

2 Tests for Bacterial Meningitis PEDS

A
  1. Kernig’s Sign→ The “Popliteal Angle” one
  2. Brudzinski’s Neck Sign→ The “hooklying and lift head” one→ tenses the Dura + recreates sx’s
87
Q

Systems Review: CV & Pulmonary

Asthma

Triggers*

A

*low lvls phys act= 35% inc risk dev. asthma

  • Resp infxs, cig smoke, allergic rxns, pollutants, exercise*, cold, emotions, GERD, Aspirin/NSAID/sulfite sensitive, Beta blockers, obesity, irritants (think sprays)
88
Q

Systems Review: CV & Pulmonary

Asthma

S/S

A

Wheezing, prolonged expiration, cough, SOB*

89
Q

Systems Review: CV & Pulmonary

Asthma

INC’ing Severity s/s

A

HR>120 bpm

O2sat <91%

“Tripod Position” (you know this)

90
Q

How do we evaluate asthma?

A

Spirometer

*measure Expiratory flow

91
Q

Systems Review: CV & Pulmonary

Asthma Tx

KNOW THIS!!!! IMPORTANT!!!!!

A
  • FEV-1 should INC by 15% after 2 puffs of inhaler w/in 5 mins
  • NEED return to baseline to return to play*******
    • This is why we take baseline!!!!!!
  • *remember Ex she gave about camp!!!!!
92
Q

Tx of asthma after attack or BEFORE return to play

What NEEDS to happen?

A

FEV-1 should INC by 15% after 2 puffs of inhaler w/in 5 mins

*NEED return to baseline BEFORE return to play!!!!

93
Q

Spleen Palpation

LEFT SIDE

A

LEFT SIDE!!!

  • Same as you would do the liver/gallbladder but on LEFT
    • hook under ribs and ask to INHALE and dig hand in
  • Red Flag: if spleen palpable, probably is enlarged; reproduction of sx’s
94
Q

Sickle Cell Dis. came from

A

Malaria

95
Q

Systems Review: CV & Pulmonary

Sickle Cell Dis.

FACTS

A
  • When born w/ it→ is not possible to predict which sx’s appear, when start, or how bad
  • Almost ALL sickle cell pts have painful crises @ some point in lives
96
Q

Systems Review: CV & Pulmonary

Sickle Cell Red Flags

3 times when sx’s present

A
  1. Sx’s during preseason conditioning
  2. Sx’s w/ intense exercise
  3. Sx’s @ altitude
97
Q

Sickle Cell Red Flags

A

Heat intolerance, Severe mm cramping, HypERventilation, Tachycardia, HypOtension

98
Q

Sickle Cell S/S:

A
  • Crises occur w/ Sickling→ RBCs block blood flow to limbs/organs*
  • Acute pain→ mild-severe and last hrs to week+
  • Repeated crises damage tissue
  • Risks inc w/ dehydration
  • NOTE: Epinephrine (from exercise) may may sickled RBCs sticky
99
Q

Sickle Cell Complications

ALL first

A
  • Hand-Foot Syndrome
  • Splenic Crisis
  • Infx’s, Ulcers
  • Acute Chest Syndrome
  • Pulm HTN, Stroke
  • Rhabdo
100
Q

Sickle Cell Complications

Hand-Foot Syndrome

A

SMALL blood vessels blocked

101
Q

Sickle Cell Complications

Splenic Crisis

A

Filters abnormal RBCs=> enlargement (may need transfusion)

102
Q

Sickle Cell Tx

A

IMMEDIATE O2, AGGRESSIVE fluid replacement, Electrolytes prn, monitor vitals!

RTP== graduated return when asymptomatic

103
Q

When you see Epstein-Barr Virus (Mononucleosis) think…..

A

SPLEEN patho****

104
Q

Spleen patho:

Epstein-Barr Virus aka

A

Mono!!!!

105
Q

Spleen Patho:

Epstein-Barr Virus (Mononucleosis)

What is the Symptom TRIAD

A

Lasts 1-4wks

  • Fever
  • Sore Throat
  • Swollen Lymph glands
106
Q

Epstein Barr (Mono) is a ______ virus

A

DNA

107
Q

Main Sx’s of Infectious Mono

A

see pics

NOTE: Spleen enlargement (BIG for return to phys act***)

108
Q

Mononucleosis

BIG things to know

A
  • MOST common presentation→ 3-5d prodrome of low grade HA, malaise, fatigue, decd appetite & mm soreness
  • Lymph nodes in back of neck particularly stand out
109
Q

Tx of Mono

BIG things to know

A
  • Self-care, plenty of rest
  • AVOID contact sports & heavy lifting→ Impact or straining could cause enlarged spleen to burst*****
  • Corticosteroids in severe cases*
110
Q

Mono:

Return to Activity:

A
  • 50% w/ mono develop enlarged spleen bw day 6 to day 21***
  • Abdominal US=> easy to obtain exam that can measure size of spleen
  • Palpation of spleen→ fluctuates in size up to 2cm t/o day*
111
Q

Mono:

Return to Activity

Restrictions to AVOID life-threatening complications:

A

Drs restrict athlete from ALL phys act for 21d

Time clock starts when athlete presents to Dr. ***

112
Q

Systems Review: Integumentary

IMPETIGO (bacterial)

A

Nightmare for Daycare along w/ Pink Eye

  • Peak prevalence→ Pre-K
  • Contagious→ via DIRECT CONTACT w/ infx area
  • Around nose & mouth
  • Characteristics→ blister that burst, ooze fluid, develop honey-colored crust
  • Scratching spreads it
113
Q

Systems Review: Integumentary

IMPETIGO (bacterial)

RTS

A

AFTER antibx 72hrs

NO drainage

114
Q

Systems Review: Integumentary

Ringworm (fungal)

*usually only occurs ABOVE WAIST

A
  • Fungal
  • Contagious→ DIRECT skin contact w/ infx person or INDIRECT w/ obj infx person touched
  • Rash→ 4-14d AFTER contact
    • usually only ABOVE waist***
115
Q

Systems Review: Integumentary

Ringworm

RTS

A

AFTER anti-fungal for 72hrs

MUST be covered

116
Q

Systems Review: Integumentary

Warts

A

VIRAL

US works good→ slough off

117
Q

What should you remember about MRSA (Methicillin Resistant Staphylococcus)

A

ANTIBIOTIC-RESISTANT!!!!!!!!!!

118
Q

MRSA

*Antibiotic-Resistant!!!!

Vehicles of Transmission:

A

Towels, waterbottles, Hot&Cold packs**, velcro straps, Wts, US applicator*, Electrodes*, Stethoscope*

NOTE: in picture, looks like pimple, BUT in random spot where you would not normally have pimple***

119
Q

Systems Review: Integumentary

Lyme Disease

Causative agent======

A

Spirochete

  • Initial transfer of bacteria→ infected tick

*Bulls-eye target!!!!

120
Q

Systems Review: Integumentary

Lyme Dis. Dx

Antibodies and pregnant women

A
  • Anti-body testing may be false-negative if performed BEFORE antibody response (<4-6wks)
  • Pregnant & suspect Lyme→ contact physician IMMEDIATELY!
    • Untreated→ infx of placenta
121
Q

Lyme Disease

More common rash locations?????

A

Hairline, Feet

More common, tick likes to burrow here

122
Q

Systems Review: Integumentary

Lyme Disease

Talk about the rash

A
  • Rash w/ erythema w/in 7-14d (ranges 3-30d)
  • May/may not be warm to palpation
  • May be solid red OR central spot w/ rings (BullsEye)
  • Usually NOT painful/itchy
123
Q

Systems Review: Integumentary

Lyme Disease

S/S

A

Fever, malaise, HA, mm aches, Jt pain (lg jts→ knee)

Cranioneuropathy→ ESP CN VII (Facial)

124
Q

Systems Review: Integumentary

Lyme Disease

Talk about the BullsEye….why BullsEye?

A
  • 2 Inflammatory rxns:
    1. Salivary PROs→ Stay put
    2. Bacteria moving AWAY from site of bite
  1. Causes rash to expand, hence BullsEye*
125
Q

Systems Review: Integumentary

Lyme Disease

Treatment?

A
  • Meds→ antibx
  • 2-4 wk course or until sx’s resolve
  • Reinstitute tx upon relapse
126
Q

Can Lyme Disease be cured?

A
  • No test to prove cure
  • Tests→ detect antibodies to fight off bacteria
    • Antibodies can persist long after infx gone
  • IF blood test (+), likely cont. to test (+) mos or yrs even tho bacteria no longer present
127
Q

Chronic Lyme Disease

A

aka Post-Tx Lyme Disease

Sx’s persist after antibx tx

NOTE: MSK sx’s are TOP***

128
Q

Systems Review: GI

Visceral Pathology:

Blumberg Sign (Rebound Tenderness)

A
  • SUPINE→ select site AWAY FROM PAINFUL AREA & place hand on abdomen
  • Push down slow & deep, hold for a moment then lift up quickly
  • Red Flag: (+)= pain on release; (-)= no pain
129
Q

Systems Review: GI

Celiac Disease (MalABSORPTION Syndrome)

A
  • Chronic systemic autoimmune disorder→ triggered in genetically susceptible indiv by Gluten PROs (wheat, barley, rye)
    • Must have genetic disposition & antigen exposure
  • HLA-DQ2 & HLA-DQ8
130
Q

Celiac Disease

WHO?

A

FEMALES 2.5x > Males

131
Q

Celiac Disease

Dx= Serologic Test

Describe 2:

A
  1. (+) TG antibody== tissue Transglutaminase
    1. enzyme in EVERY tissue that joins PROs
      1. Sn= 89%
      2. Sp= 98% (good DIAGNOSTIC test*)
    2. IgA anti-endomysial antibody (EMA)
      1. Sn=90%
      2. Sp= 99% (good DIAGNOSTIC test*)
132
Q

This is a good DIAGNOSTIC test for Celiac Disease

*you starred and boxed it so KNOW IT!!!!

A

IgA anti-endomysial antibody (EMA)

Sn= 90%

Sp= 99% (good Dx test!!!!)

133
Q

Celiac Iceberg

Onset and Sx’s

A
  • Onset:
    • 6-24mos AFTER gluten introduced to diet
  • Sx’s:
    • Diarrhea, abdom distention
    • Impaired growth, mm wasting
    • DECd appetite, wt loss
    • Lethargy, irritability

see pics NOTE stages : 1. Latent 2. Silent 3. Symptomatic

134
Q

Systems Review: GI

Celiac Disease

MORE S/S:

A
  • Short stature (DEC pituitary release of GH)
  • Osteoporosis (OP)→ Ca++ malabsorption
  • Infertility
  • Asthenia (mm weakness)
  • Diarrhea, abdom distention/pain, Vom, Wt loss
  • HypOtension
  • Intense pruritic rash over buttocks, scalp, face, elbows, knees***
135
Q

Small Bowel Villi

Normal vs. W/ Celiac (scarred villi)

A

see pics

136
Q

Diminished RBC production due to LOW iron stores

A

Anemia

137
Q

Anemia

What is it?

A

Diminished RBC production due to LOW iron stores

138
Q

Anemia

Findings:

A
  • DEC Hemoglobin
  • DEC Hematocrit
  • Changes in fingernail beds
  • Pale skin color
  • Fatigue
  • DEC DBP
139
Q

WHY do athletes need more Iron?

A

Excessive exercise can INC blood volume & cause imbalance in the ratio b/w Blood & Iron***

140
Q

RDA for Iron

A

see chart

141
Q

What type of Iron absorbs MOST/FASTEST?

A

Iron (ferrous) Gluconate

142
Q

Impact on Absorption of Iron

Only known substances to inhibit absorption of both non-heme & heme iron

A
  • Ca++ found in foods such as milk, yogurt, cheese, sardines, canned salmon, tofu, broccoli, almonds, figs, turnip greens & rhubarb
143
Q

Appendix patho

Appendicitis

3 things to know about this:

A
  1. Obstruction
  2. Inflammation
  3. Infection
144
Q

Appendicitis

MOST common s/s→ Least

A
  • RLQ pain
  • (+) McBurney’s point=> R thigh/testicle
  • Nausea, vom, night sweats
  • Guarding of rectus abdominis
  • (+) psoas sign, (+) obturator sign
  • Low-grade fever unless assocd w/ perforation (then high fever)
  • (+) Rebound Tenderness (Blumberg)
  • Position of Relief: tense abdomen w/ FB or lie down w/ both knees to chest
145
Q

Appendicitis

Pos. of Relief

A

Tense abdomen w/ FB OR lie down w/ both knees to chest

146
Q

Appendicitis

Intolerance of jarring tasks (you’ll notice)

A

Bouncing a child on your knee, Unwillingness to jump or hop

147
Q

Appendicitis

Modality of choice (to dx)?

A

Ultrasound imaging

Other tests in pics→ McBurney’s, Psoas sign, Obturator sign

148
Q

Systems Review: Endocrine

DM Schematic

A

see pics and NOTE Steps 1-5

  1. Stomach changes food into glucose
  2. Glucose enters bloodstream
  3. Pancreas makes little or NO insulin*
  4. Little or no insulin enters bloodstream (to pull glucose into cells)
  5. Glucose builds up in bloodstream
149
Q

Systems Review: Endocrine

Diabetes

Type 1- Juvenile DM

A
  • High lvls sugar in blood/urine
  • Freq urination→ lg volumes (kidney trying to flush excess glucose)
  • Abnorm thirst (attempts to replace fluid loss)
  • Extreme hunger but LOSES WEIGHT
  • Blurred vision*
  • Fatigue, irritable, mood change (no glucose for energy)
  • Abdom pain, nausea, vom, fruity smelling breath (ketones)
  • Onset of bedwetting in child w/ no prior px
  • Vaginal yeast infx in female prior to puberty (Infx’s love sugar*)
150
Q

Systems Review: Urogenital

Cystitis-Pyelonephritis aka

A

UTI

151
Q

Systems Review: Urogenital

Cystitis-Pyelonephritis (UTI)

Talk about it

A
  • Pain w/ micturition (urination)
  • Leukocytes (WBCs) & bacteria in urine (white casts)
  • Cloudy, malodorous urine
  • Back pain*
  • Fever, chills, nausea
  • Loss of appetite
  • Pain w/ percussion over kidneys*
152
Q

When you see eating disorders, Anorexia, think….

A

Starving

153
Q

Eating Disorders→ Anorexia (starving)

WE are on front lines of ID’ing this!!!!

A
  • UNDER min. bw
  • Fear of being fat
  • Freq starving
  • Depressed/ w/drawn
  • Self-induced vomiting
  • Excessive exercise*
  • Amenorrhea*
  • Bradycardia, HypOtension, Arrhythmias→ Triad of anorexia
  • Dry skin, dental caries, anemia, OP
154
Q

Anorexia

Triad of sx’s

A

Bradycardia, HypOtension, Arrhythmias

155
Q

Eating disorders, Bulemia, think……

A

Binge, purge, self-induced vomiting

156
Q

Eating Disorders→ Bulemia

A

Binge & Purge

  • Binge eating
  • Over-eating w/ pd of starvation
  • Self-induced vomiting
  • Laxatives, diuretics
  • Excessive exercise* (in common w/ Anorexia)
  • Fear of fatness* (in common w/ Anorexia)
  • May be obese
  • Erosion of dental enamel (from all self-induced vomiting)
  • SZ
  • Weakness/fatigue
157
Q

Leading Causes of Death

15-19yo

A

NOTE: Neoplasms

158
Q

Peds/Adolescent Cx

Leukemia

What do you need to remember about Leukemia????

A

Diff to dx bc of the similarity to NORMAL childhood dis’s****

159
Q

Peds/Adolescent Cx

Leukemia

A

*Diff to dx bc of similarity to NORM childhood dis’s

  • Slow OR rapid onset
  • Fever & loss of appetite, pale skin & freq bruising
  • Enlarged cervical lymph nodes (>1cm, firm/rubbery, >1mo=RED FLAG), abdominal protrusion 2* enlarged spleen & liver
160
Q

BIG STANDOUTS W/ LEUKEMIA

A

Enlarged cervical lymph nodes, abdominal protrusion 2* enlarged spleen and liver

NOTE: Lymph nodes >1cm, firm/rubbery, >1mo==> RED FLAG***

161
Q

MOST COMMON SOLID TUMOR OF CHILDREN UNDER 5yo

A

Neuroblastoma (abdominal tumor)

162
Q

What should you remember about Neuroblastoma (abdom tumor)????

A

MOST COMMON SOLID TUMOR OF CHILDREN UNDER 5yo****

163
Q

Peds/Ado Cx

Neuroblastoma

A

Abdominal tumor

  • MOST COMMON SOLID TUMOR OF CHILDREN UNDER 5yo
  • Originates→ SNS tissue
  • MOST common site→ abdomen near adrenal gland
  • 1st Signs→ Fatigue/Loss of appetite
  • Abdom swelling may result in→ constipation, px w/ urination, breathlessness
164
Q

Peds/Ado Cx

Pilocytic Astrocytoma (brain tumor)

A
  • Peaks 5-14yo
  • HA (90%)→ WORSE in AM and INCs w/ activity, Valsalva, stooping
    • INC in intracranial pressure→ Put them in prone and assess sx’s→ they will NOT like it!!!
  • SZs
  • Visual changes, vomiting, Ataxia*
165
Q

Peds/Ado Cx

OSTEOsarcoma (bone tumor)

WHAT SHOULD YOU REMEMBER ABOUT THIS????

A

MOST COMMON BONE CX IN ADOLESCENCE!!!!

166
Q

MOST COMMON BONE CANCER IN ADOLESCENCE

A

OSTEOSARCOMA

167
Q

Peds/Ado Cx

Osteosarcoma (bone tumor)

A

MOST COMMON bone cx in adolescence

  • Boys 2x > girls
  • MOST COMMON BONES→ Femur, tibia, fibula (long bones)
  • Pain/swelling that gets WORSE w/ exercise or @ night***
  • Pathologic fx may eventually occur

MI Differential Diagnosis & Med Screening (12 decks)

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