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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
Systems Review: **Musculoskeletal** ## Footnote **Ehlers-Danlos Syndrome** **GUIDELINES TO FOLLOW GIVEN NATURE OF DISEASE AND BC ITS A CONNECTIVE TISSUE DISORDER!!!!**
NO **stretching** ## Footnote **Stabilization\*\*\*\***
26
Systems Review: **Musculoskeletal** ## Footnote **Congenital Hip Dysplasia aka Developmental Dysplasia of the Hip (DDH)**
see pics
27
Systems Review: **Musculoskeletal** ## Footnote **Congenital Hip Dysplasia (DDH)** **Pathogenesis**
* **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\*\*\***
28
MOST COMMON HIP ABNORMALITY IN NEWBORNS
Congenital Hip Dysplasia DDH
29
Baby hips by #s
* **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\*\*\*
30
Systems Review: **Musculoskeletal** ## Footnote **Congenital Hip Dysplasia (DDH)** **Clinical Presentation**
* AFTER 6wks→ hip may not reduce * **Asymmetry→ Thighs or Gluteal folds** * **LIMITS in→ Hip ABD** * **Unequal _femoral length_** * **Uneven Knees==\> Galeazzi's Sign**
31
Systems Review: **Musculoskeletal** ## Footnote **Congenital Hip Dysplasia (DDH)** **Clinical Presentation: talk about _Gait Pattern:_**
* **_Abnormal_ Gait Pattern:** * Toe-walking, IN-toeing or OUT-toeing * **NOTE: (+) Ortolani and Barlow test present**
32
Systems Review: **Musculoskeletal** ## Footnote **Congenital Hip Dysplasia (DDH)** **2 tests that we perform**
1. **O**rtoloan**i** test→ OUT to IN 2. Bar**low** test→ (dis**lo**cate)
33
DDH/Congenital Hip Dysplasia ## Footnote **Ortolani Test** **\*remember OUT→IN**
**OUT→ IN** **Relocating femoral head INTO acetabulum**
34
DDH/Congenital Hip Dysplasia **BarLOW (disLOcate) Test**
Dis**LO**cate **Subluxing** femoral head
35
Systems Review: **Musculoskeletal** ## Footnote **DDH/Congenital Hip Dysplasia** **INTERVENTION**
* **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
36
\***Cardinal Rule for Child w/ _Knee pain_:**
ALWAYS EVALUATE THE **HIP!!!!!**
37
AVN of hip OR ## Footnote **Legg-Calve-Perthes Disease** **WHO?**
Boys 3-13 (avg 5-7yo) see pics
38
Systems Review: **Musculoskeletal** ## Footnote **AVN/Legg-Calve-Perthes Disease** **S/S:**
* PAIN→ groin, buttock, **prox. thigh** * Exacerbated by **WB** * DECd **hip IR + ABD ROM** * Antalgic gait * **Radiographs:** * coxa magna (broad head/neck of femur) * demineralization
39
Slipped Capital Femoral Epiphysis aka **SCFE** ## Footnote **think…..**
Cone slips out from ice cream \*\*\*\*\*
40
MOST COMMON ABNORMALITY IN **NEWBORNS**
DDH
41
MOST COMMON DISORDER OF **ADOLESCENT HIP**
SCFE
42
Systems Review: **Musculoskeletal** ## Footnote **SCFE** **Epidemiology & Pathogen.**
**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_**
43
What should you **ALWAYS REMEMBER ABOUT SCFE AND _INITIAL SYMPTOM_?????**
45% have **KNEE or LOWER THIGH PAIN** as **_Initial Symptom_\*\*\***
44
45% have **KNEE or LOWER THIGH PAIN** as **_Initial Symptom_\*\*\* w/ this abnormality**
SCFE\*\*\*\*
45
Systems Review: **Musculoskeletal** ## Footnote **SCFE** **Dx & Intervention**
\***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
46
Systems Review: **Musculoskeletal** ## Footnote **Transient Hip Synovitis aka ________ aka \_\_\_\_\_\_**
Toxic Synovitis ## Footnote **Phantom hip disease**
47
Systems Review: **Musculoskeletal** ## Footnote **Transient Hip Synovitis aka Toxic Synovitis aka Phantom Hip Dis.**
* _Acute pain_ **W/OUT any assod MSK or constitutional sx's** * **Maaaaaybe limp** * Child **afebrile (no fever)**
48
Systems Review: **Musculoskeletal** ## Footnote **Transient Synovitis aka Toxic Synovitis aka Phantom Hip Dis.** **Dx Tests**
* Normal or **mildly** elevated CBC, ESR, & C-Reactive PRO lvls * X-ray→ NORMAL * Hip US→ maybe effusion
49
Transient Synovitis ## Footnote **Tx?**
Self-limiting w/ **oral analgesics**
50
Transient Synovitis ## Footnote **THIS dx has _similar EARLY presentation_ BUT w/ addition of fever**
Septic Arthritis * Addition of fever * Reqs **emergent surgical drainage & IV antibx**
51
MOST COMMON TYPE OF **SALTER-HARRIS Fx**
Type 2 ## Footnote **Through growth plate AND metaphysis**
52
**Salter-Harris Epiphyseal Fx Classification** **S.A.L.T.R**
* **S: S**eparated * **A: A**bove * **L: L**ower * **T: T**hrough * **R: R**ammed
53
Multiple Stress Fx's ## Footnote **3 Reasons:**
1. Training prob 2. Nutrition prob 3. Eating disorder
54
Stress Fx's
* 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
55
70% Stress Fx's due to:
**Metabolic abnormalities OR Nutritional deficits**
56
Stress Fx ## Footnote **Risk Factors:**
* \>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\*\*\*
57
Stress Fx Risk ## Footnote **Female Triad:**
Eating disorder→ Amenorrhea→ Osteoporosis
58
Stress Fx's ## Footnote **S/S**
* **Swelling** INC w/ activity, **Pain** INC w/ activity * **Point tenderness** * **Earlier** onset of pain w/ **ea successive workout** * Continued pain **@ rest as damage progresses**
59
Stress Fx's and X-ray
**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\*\*\***
60
Stress Fx ## Footnote **Plain films**
**(-) 30-70% of time** GREAT **screening tool (high Sn)**
61
Stress Fx's ## Footnote **Clinical Techniques**
* US * **Vibratory Pain:** * Sn= 75% * Sp= 67% * Tuning Fork * 128Hz, **256Hz\*\*\*,** 512Hz
62
Tuning Fork for Stress Fx ## Footnote **Hz to use?**
256 Hz
63
Stress Fx's ## Footnote **Bone Scan**
**(+) w/in 1-8days**
64
Stress Fx ## Footnote **MRI**
Sn=90% good **screening** tool HIGH cost tho
65
Ottawa Ankle & Foot Rules Great **SCREENING** tool
\*Tell you whether **radiograph** needed!! * Adults: * **Sn= 95-100%\*\*\* (Screening tool)** * **Sp= 16%** * Children: * **Sn= 83-100%\*\*\*\* (Screening tool)** * **Sp= 21-50%**
66
Osteoporosis ## Footnote **2 Notes**
1. Starts as a **child\*** 2. We want to **START w/ GOOD bone stock\*\*\*** 3. **High calcium foods, exercise regularly, no smoking @ young age**
67
Forces on Humerus during throwing Richard Souza, 2014
Throwing side thicker Opp arm loses bone stock\*\*\*
68
Fitness & Bone Strength & Structure in 3-5yo Children
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
Systems Review: **Musculoskeletal** ## Footnote **Hernia** **3 types:**
1. Femoral 2. Inguinal 3. Sports (**Athletic Pubalgia\*)**
70
Hernia ## Footnote **High risk sports:**
Soccer, Football/Rugby, Ice hockey ## Footnote **\*constant cut and load**
71
Systems Review: **Musculoskeletal** ## Footnote **Sports Hernia (Athletic Pubalgia)** **Clinical Presentation:**
* 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
Tug of War is a test for \_\_\_\_\_\_\_\_\_
Sports Hernia ## Footnote **Athletic Pubalgia**
73
Tug of War ## Footnote **Athletic Pubalgia (sports hernia)** **More females now** **What muscles ?**
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
Systems Review: **Musculoskeletal** ## Footnote **Sinding-Larsen-Johansson Syndrome (SLJ) vs. Osgood Schlatter Syndrome (OSS)**
* **NORTH SIDE→** Sinding-Larsen-Johansson Syndrome (SLJ) * **SOUTH SIDE→** Osgood Schlatter Syndrome (OSS)- **think 2 S's so this is **_S_**outh **_S_**ide** **NOTE: BOTH _UNDER_ patella \*\*\*\***
75
Systems Review: **Musculoskeletal** ## Footnote **Patello-Femoral Tracking** **ACL Prediction** **Dynamic Jump Test**
Sn= 67-87% Sp= 60-72%
76
Hip Mechanics w/ **PFP (knee)**
* 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
Dynamic Q-Angle ## Footnote **Descending Stairs**
Control= 24\* (valgus) PFS= 39\* (valgus)
78
Atrophy of the quads is **NOT** isolated to **vastus medialis oblique (VMO)** in indivs w/ PFP\*\*\*
* 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
HIP is the answer w/ PFP
* Systemic review concluded studies including **Hip ER & ABD's w/ quad strengthening had LOWER pain values & better functioning than quad strengthening alone**
80
Strength Ratios for Hip ABD and Hip ER
* **Hip ABD=** 30deg of ABD & HHD 10cm proximal to lateral femoral condyle * **Hip ER=** sitting 90/90, HHD just proximal to medial malleolus
81
Take Home Message ## Footnote **Patellar tracking or ACL problem**
* **Clinical cutoff to define _HIGH RISK:_** * Hip ABD \<35.4% of bw * Hip ER \<20.3% of bw
82
Horse is Dead!!!!
* **_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
Systems Review: **Neuromuscular** ## Footnote **Bacterial Meningitis** **\*MEDICAL EMERGENCY IN CHILDREN!!!!** **Contagious & S/S**
* **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
**Paradoxic Irritability** think….
PEDS→ **Bacterial Meningitis** ## Footnote **Do not want to be touched or moved. What orig soothes them makes it _worse_**
85
Bacterial Meningitis ## Footnote **Distinguishing bw Bacterial vs. Viral**
* **Bacterial→** gets into bloodstream via **cough/sneeze, kiss, foods, trauma** * **Viral→** LESS severe; enters via **GI or Resp.**
86
2 Tests for **Bacterial Meningitis PEDS**
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
Systems Review: **CV & Pulmonary** ## Footnote **Asthma** **Triggers\***
\*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
Systems Review: **CV & Pulmonary** ## Footnote **Asthma** **S/S**
Wheezing, prolonged **expiration,** cough, SOB\*
89
Systems Review: **CV & Pulmonary** ## Footnote **Asthma** **INC'ing Severity s/s**
HR\>120 bpm O2sat \<91% “Tripod Position” (you know this)
90
How do we **evaluate** asthma?
**Spirometer** **\*measure _Expiratory_ flow**
91
Systems Review: **CV & Pulmonary** ## Footnote **Asthma Tx** **KNOW THIS!!!! IMPORTANT!!!!!**
* **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
**Tx of asthma after attack or BEFORE return to play** **What NEEDS to happen?**
FEV-1 should INC by **15%** after 2 puffs of inhaler **w/in 5 mins** ## Footnote **\*NEED return to baseline BEFORE return to play!!!!**
93
**Spleen** Palpation LEFT SIDE
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
Sickle Cell Dis. came from
Malaria
95
Systems Review: **CV & Pulmonary** ## Footnote **Sickle Cell Dis.** **FACTS**
* 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
Systems Review: **CV & Pulmonary** ## Footnote **Sickle Cell Red Flags** **3 times when sx's present**
1. Sx's during **preseason conditioning** 2. Sx's w/ **intense exercise** 3. Sx's **@ altitude**
97
Sickle Cell **Red Flags**
Heat intolerance, Severe mm cramping, HypERventilation, Tachycardia, HypOtension
98
Sickle Cell S/S:
* 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
Sickle Cell Complications ALL first
* Hand-Foot Syndrome * Splenic Crisis * Infx's, Ulcers * Acute Chest Syndrome * Pulm HTN, Stroke * Rhabdo
100
Sickle Cell Complications ## Footnote **Hand-Foot Syndrome**
SMALL blood vessels blocked
101
Sickle Cell Complications ## Footnote **Splenic Crisis**
Filters **abnormal RBCs=\> enlargement (may need transfusion)**
102
Sickle Cell Tx
IMMEDIATE O2, AGGRESSIVE fluid replacement, Electrolytes prn, monitor vitals! **RTP==** graduated return when **asymptomatic**
103
When you see **Epstein-Barr Virus (Mononucleosis) think…..**
**SPLEEN patho\*\*\*\***
104
Spleen patho: ## Footnote **Epstein-Barr Virus aka**
Mono!!!!
105
Spleen Patho: ## Footnote **Epstein-Barr Virus (Mononucleosis)** **What is the Symptom _TRIAD_**
**Lasts 1-4wks** * Fever * Sore Throat * Swollen Lymph glands
106
Epstein Barr (Mono) is a ______ virus
DNA
107
Main Sx's of **Infectious Mono**
see pics ## Footnote **NOTE: Spleen enlargement (BIG for return to phys act\*\*\*)**
108
Mononucleosis ## Footnote **BIG things to know**
* **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
Tx of Mono ## Footnote **BIG things to know**
* Self-care, plenty of rest * **AVOID contact sports & heavy lifting→** Impact or straining **could cause enlarged spleen to burst\*\*\*\*\*** * **Corticosteroids in severe cases\***
110
Mono: ## Footnote **Return to Activity:**
* 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
Mono: ## Footnote **Return to Activity** **Restrictions to AVOID life-threatening complications:**
Drs restrict athlete from **ALL phys act for 21d** ## Footnote **Time clock _starts_ when athlete presents to Dr. \*\*\***
112
Systems Review: **Integumentary** ## Footnote **IMPETIGO (bacterial)**
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
Systems Review: **Integumentary** ## Footnote **IMPETIGO (bacterial)** **RTS**
AFTER antibx 72hrs ## Footnote **NO drainage**
114
Systems Review: **Integumentary** ## Footnote **Ringworm (fungal)** **\*usually only occurs ABOVE WAIST**
* 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
Systems Review: **Integumentary** ## Footnote **Ringworm** **RTS**
AFTER anti-fungal for 72hrs ## Footnote **MUST be _covered_**
116
Systems Review: **Integumentary** ## Footnote **Warts**
VIRAL US works good→ slough off
117
What should you remember about **MRSA (Methicillin Resistant Staphylococcus)**
ANTIBIOTIC-RESISTANT!!!!!!!!!!
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MRSA **\*Antibiotic-Resistant!!!!** **Vehicles of Transmission:**
Towels, waterbottles, Hot&Cold packs\*\*, velcro straps, Wts, US applicator\*, Electrodes\*, Stethoscope\* ## Footnote **NOTE: in picture, looks like pimple, BUT in random spot where you _would not normally have pimple_\*\*\***
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Systems Review: **Integumentary** ## Footnote **Lyme Disease** **Causative agent======**
Spirochete * **Initial transfer of bacteria→** infected tick \***Bulls-eye target!!!!**
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Systems Review: **Integumentary** ## Footnote **Lyme Dis. Dx** **Antibodies and pregnant women**
* Anti-body testing may be **false-negative** if performed BEFORE antibody response (\<4-6wks) * **Pregnant & suspect Lyme→** contact physician IMMEDIATELY! * Untreated→ infx of placenta
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Lyme Disease ## Footnote **More common rash locations?????**
Hairline, Feet ## Footnote **More common, tick likes to burrow here**
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Systems Review: **Integumentary** ## Footnote **Lyme Disease** **Talk about the rash**
* 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
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Systems Review: **Integumentary** ## Footnote **Lyme Disease** **S/S**
Fever, malaise, HA, mm aches, Jt pain (lg jts→ knee) ## Footnote **Cranioneuropathy→ ESP CN VII (Facial)**
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Systems Review: **Integumentary** ## Footnote **Lyme Disease** **Talk about the BullsEye….why BullsEye?**
* **2 Inflammatory rxns:** 1. **Salivary PROs→** Stay put 2. **Bacteria** moving **AWAY from site of bite** 1. **Causes rash to expand, hence BullsEye\***
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Systems Review: **Integumentary** ## Footnote **Lyme Disease** **Treatment?**
* Meds→ antibx * 2-4 wk course or until sx's resolve * **Reinstitute tx upon relapse**
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Can **Lyme Disease** be cured?
* 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
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Chronic Lyme Disease
aka **Post-Tx Lyme Disease** ## Footnote **Sx's persist after antibx tx** **NOTE: MSK sx's are TOP\*\*\***
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Systems Review: **GI** ## Footnote **_Visceral_ Pathology:** **Blumberg Sign (Rebound Tenderness)**
* 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**
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Systems Review: **GI** **Celiac Disease (MalABSORPTION Syndrome)**
* **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
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Celiac Disease **WHO?**
**FEMALES** 2.5x \> Males
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Celiac Disease ## Footnote **Dx= Serologic Test** **Describe 2:**
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\*)**
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This is a good **DIAGNOSTIC test** for Celiac Disease \*you starred and boxed it so KNOW IT!!!!
IgA anti-endomysial antibody **(EMA)** Sn= 90% **Sp= 99% (good Dx test!!!!)**
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Celiac Iceberg ## Footnote **Onset and Sx's**
* **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_**
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Systems Review: **GI** ## Footnote **Celiac Disease** **MORE S/S:**
* **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\*\*\***
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Small Bowel Villi ## Footnote **Normal vs. W/ Celiac (scarred villi)**
see pics
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Diminished **RBC production** due to **LOW iron stores**
Anemia
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Anemia ## Footnote **What is it?**
Diminished **RBC production** due to **LOW iron stores**
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Anemia ## Footnote **Findings:**
* DEC **Hemoglobin** * DEC **Hematocrit** * Changes in **fingernail beds** * **Pale** skin color * Fatigue * DEC **DBP**
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WHY do athletes need more **Iron?**
Excessive **exercise** can **INC blood volume** & cause **imbalance in the ratio b/w _Blood & Iron_\*\*\***
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RDA for Iron
see chart
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What type of Iron absorbs **MOST/FASTEST?**
Iron (ferrous) **Gluconate**
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Impact on Absorption of **Iron** ## Footnote **Only known substances to _inhibit_ absorption of both non-heme & heme iron**
* **Ca++** found in foods such as **milk, yogurt, cheese, sardines, canned salmon, tofu, broccoli, almonds, figs, turnip greens & rhubarb**
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Appendix patho ## Footnote **Appendicitis** **3 things to know about this:**
1. Obstruction 2. Inflammation 3. Infection
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Appendicitis ## Footnote **MOST common s/s→ Least**
* **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
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Appendicitis ## Footnote **Pos. of Relief**
Tense abdomen w/ FB OR lie down w/ both knees to chest
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Appendicitis ## Footnote **Intolerance of jarring tasks (you'll notice)**
Bouncing a child on your knee, Unwillingness to jump or hop
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Appendicitis ## Footnote **Modality of choice (to dx)?**
Ultrasound imaging Other tests in pics→ McBurney's, Psoas sign, Obturator sign
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Systems Review: **Endocrine** ## Footnote **DM Schematic**
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**
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Systems Review: **Endocrine** ## Footnote **Diabetes** **Type 1- _Juvenile_ DM**
* 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\*)**
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Systems Review: **Urogenital** ## Footnote **Cystitis-Pyelonephritis aka**
UTI
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Systems Review: **Urogenital** ## Footnote **Cystitis-Pyelonephritis (UTI)** **Talk about it**
* 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\***
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When you see eating disorders, **Anorexia, think….**
Starving
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Eating Disorders→ **Anorexia (starving)** ## Footnote **WE are on front lines of ID'ing this!!!!**
* 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
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Anorexia ## Footnote **Triad of sx's**
Bradycardia, HypOtension, Arrhythmias
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Eating disorders, **Bulemia, think……**
Binge, purge, self-induced vomiting
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Eating Disorders→ **Bulemia**
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
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Leading Causes of Death **15-19yo**
NOTE: **Neoplasms**
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Peds/Adolescent Cx ## Footnote **Leukemia** **What do you need to remember about Leukemia????**
**Diff to dx bc of the _similarity to NORMAL childhood dis's_\*\*\*\***
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Peds/Adolescent Cx ## Footnote **Leukemia**
\***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**
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BIG STANDOUTS W/ **LEUKEMIA**
**Enlarged cervical lymph nodes, abdominal protrusion 2\* enlarged spleen and liver** **NOTE: Lymph nodes \>1cm, firm/rubbery, \>1mo==\> _RED FLAG_\*\*\***
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**MOST COMMON _SOLID TUMOR_ OF CHILDREN UNDER 5yo**
Neuroblastoma (**abdominal tumor)**
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What should you remember about **Neuroblastoma (abdom tumor)????**
MOST COMMON **SOLID TUMOR** OF **CHILDREN UNDER 5yo\*\*\*\***
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Peds/Ado Cx ## Footnote **Neuroblastoma**
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
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Peds/Ado Cx ## Footnote **Pilocytic Astrocytoma (brain tumor)**
* **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\*
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Peds/Ado Cx ## Footnote **OSTEOsarcoma (bone tumor)** **WHAT SHOULD YOU REMEMBER ABOUT THIS????**
MOST COMMON **BONE CX IN ADOLESCENCE!!!!**
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MOST COMMON **BONE CANCER** IN **ADOLESCENCE**
OSTEOSARCOMA
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Peds/Ado Cx ## Footnote **Osteosarcoma (bone tumor)**
**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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