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Clin Med IV Exam III > Misc Peds Lecture > Flashcards

Misc Peds Lecture Flashcards

1
Q

What is strabismus

A

a anomaly of ocular alignment that can be unilateral or bilateral

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2
Q

Types of strabismus

A

eso—> nasal
exo—> temporal

latent=phoria
manifest= tropia

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3
Q

Risk factors for primary strabismus

A
  • family hx
  • low birth weight
  • muscle abnormality
  • visual deprivation
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4
Q

Complications of strabismus

A
  • amblyopia
  • diplopia
  • contracture of extraoccular muscles
  • psychosocial and vocational consequences
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5
Q

Treatment of strabismus

A

medial:

  • glasses
  • miotic drops
  • patching
  • visual training exercises

Surgical:
-repositioning or shortening

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6
Q

Impetigo

A

contagious superficial bacterial infection

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7
Q

Primary vs secondary impetigo

A

primary- direct bacterial invasion of normal skin (pyoderma)

secondary- infection at site with previous mild trauma (impetigo contagiosa)

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8
Q

Who gets impetigo

A
  • kids 2 to 5 years old
  • warm, humid conditions
  • spread easily by close contacts
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9
Q

What causes impetigo

A

staph

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10
Q

What are the three types of impetigo

A
  • non bullous
  • bullous
  • ecthyma
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11
Q

Non bullous impetigo

A

vesicles surrounded by erythema and breakdown and become thick adherent crust with “honey colored” appearance

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12
Q

Bullous impetigo

A

vesicles enlarge to form flaccid bullae with clear yellow fluid which becomes darker and ruptures to form thin brown crust

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13
Q

Ecthyma

A

ulcerative form of impetigo, causes punched out ulcers w/ yellow crust that is surrounded by raised margins

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14
Q

When do you culture fluid from impetigo

A

if treatment fails

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15
Q

Topical treatment for impetigo

A
  • mupirocin

- h2O2 cream

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16
Q

Oral treatment of impetigo

A

use if bullae

  • diclox
  • cephalexin
  • clinda
  • bactrim if MRSA suspected
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17
Q

Appearance of pin worms

A

small white and threadlike

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18
Q

Where do pinworms inhabit

A
  • cecum
  • appendix
  • ileum
  • ascending colon
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19
Q

Pinworms aka ____ caused by ___

A

eterobiasis caused by enterobius vermicularis

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20
Q

Spread of pinworms

A

fecal or oral route

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21
Q

Clinical manifestations of pinworms

A
  • nocturnal perianal and perineal itching

- visible worms around anus and buttocks

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22
Q

Diagnosis of pinworms

A
  • hx of nocturnal itching
  • collection with cellophane tape or pinworm paddle
  • visual inspection of stool or anus
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23
Q

Treatment for pinworms

A
  • Albendazole: 400mg once and repeat in 2 weeks
  • pyrantel pamoate is alternative
  • treat family
  • practice good hygiene
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24
Q

erythema infectiousum aka

A

fifth disease

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25
Q

What causes erythema infectiousum

A

parovirus B19

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26
Q

How if erythema infectiousum transmitted

A

UNKNOWN

-transmission stops after symptoms develop

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27
Q

Symptoms of erythema infectiousum

A

Day 1-2: fever, headache, nausea, diarrhea

Day 2-5: slapped cheeks, circumoral pallor, reticulated rash on trunk/extremities

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28
Q

What things can make the rash in fifth disease reappear

A
  • sunlight
  • heat changes
  • exercise
  • stress
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29
Q

Treatment of erythema infectiousum

A

Supportive only

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30
Q

What can parvovirus B19 cause in adults

A
  • transient aplastic crisis
  • fetal hydrops–> fetal demise
  • arthritis/arthralgia
  • chronic symptoms
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31
Q

Cause of mono

A

EBV

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32
Q

Transmission of mono

A
  • virus shed in salivary secretions
  • found but not transmitted in breast milk
  • ? sexually transmitted
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33
Q

Incubation of mono

A

4-7 weeks

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34
Q

Classic clinical manifestation of mono

A
  • fever
  • pharyngitis
  • adenopathy
  • fatigue
  • atypical lymphocytosis
  • splenomegaly
  • rash
  • hepatitis
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35
Q

Less common symptoms of mono

A
  • splenic rupture
  • guillain barre, CN palsies, aseptic meningitis, transverse myelitis, optic neuritis
  • cholestasis
  • pneumonia
  • myocarditis
  • pancreatitis
  • mesenteric adenitis
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36
Q

Diagnosing mono?

A
  • mostly a clinical diagnosis
  • atypical lymphocytes >10% on diff
  • heterophile Ab (monospot)
37
Q

What things can turn monospot positive other than mono

A
  • leukemia
  • lymphoma
  • pancreatic cancer
38
Q

When should you consider an EBV panel

A

if a pt has sx and findings c/w mono and the heterophile remains negative after retesting 1 week later

39
Q

What should you consider in EBV panel is negative

A
  • CMV
  • HIV
  • Toxo
  • HHV 6 or 7
  • Hep B
40
Q

Treatment of mono

A
  • supportive care (hydration, antipyretics)
  • steriods if airway compromised by tonsillar hypertrophy
  • splenic rupture precautions
41
Q

What are splenic rupture precautions

A
  • 3 weeks mild activity
  • minimum 4 weeks for contact/high risk sports and activities
  • or longer if spleen remains enlarged by palpation or ultrasound
42
Q

Symptoms of measles

A
  • fever
  • cough
  • coryza
  • conjunctivitis
43
Q

Pathognomonic for measles

A

Koplik spots

-maculopapular rash that start at head

44
Q

When is measles contagious

A

4 days before rash through 4 days after rash

45
Q

Common complications of measles

A
  • OM
  • pneumonia/bronchopneumonia
  • croup
  • diarrhea
46
Q

Less common complications of measles

A
  • acute encephalitis
  • respiratory or neuro complication
  • subacute sclerosing panencephalitis (occurs 7-10 years later)
47
Q

How are the measles spread

A
  • highly contagious
  • direct contacts with droplets or airborne
  • remains on surfaces for up to 2 hours
48
Q

Testing for measles

A

-IgM antibody
-RNA by PCR
via serum or NP swab

can also get urine

49
Q

Poster exposure prophylaxis for measles

A

-MMR vaccine withing 72 hours of exposure or IG if administered within 6 days of exposure

50
Q

Treatment of severe measles in children (hospitilized). Why?

A

Vitamin A

  • deficiency contributes to delayed recovery and to the high rate of post measles complications
  • can also cause xerophthalmia–> childhood blindness
51
Q

Rubella aka

A

german measles

52
Q

Symptoms of rubella

A
  • rash and low grade fever

- lymphadenopathy and arthralgia in older kids and adults

53
Q

Complications of rubella

A

birth defects in pregnant women–> deafness, cataracts, heart defects, developmental delay, liver and spleen damage

54
Q

How is rubella transmitted

A

airborne

55
Q

Roseola is caused by what

A

HHV 6 and HHV 7

56
Q

Signs and symptoms of roseola

A
  • sudden high fever (102-104)
  • fever subsides and rash appears
  • rash trunk to arms and legs
  • rash is asymptomatic
57
Q

Kawaskai’s disease is also know as what

A

Mucocutaneous lymph node syndrome

58
Q

What is Kawaskai’s disease

A

widespread inflammation of medium sized blood vessels throughout the body

most importantly vessels of heart

59
Q

Who gets Kawaskai’s disease

A
  • kids less than 5

- boys more than girls

60
Q

What causes Kawasaki’s disease?

A

mainly unknown

  • possible infectious (winter and summer)
  • possibly genetic (asain and asain american)
61
Q

What is seen in vessel walls in Kawasaki’s disease

A

neutrophilic inflitrate

*polymorphocytes then macrophages and lymphocytes

62
Q

Clinical manifestations of Kawasaki’s disease

A
  • fever
  • conjunctivitis
  • mucositis
  • rash
  • extremity changes
  • lymphadenopathy
  • cardiovascular findings
63
Q

Fever in Kawasaki’s disease

A

fever over 100.5 lasting 5 days or longer

*kids with a fever for 5 days or longer with no obvious source think Kawasaki

64
Q

Conjunctivitis in Kawasaki’s disease

A
  • non exudative
  • bilateral
  • spares the limbus

can be accompanied by photophobia/uveitis

65
Q

Mucositis in Kawasaki’s disease

A
  • crack red lips
  • strawberry tongue

*not associated with tonsillar exudate, oral vesicles or ulcers

66
Q

Rash with Kawasaki’s disease

A
  • polymorphous
  • begins perineal with erythema with desquamations
  • then may be macular/morbilliform/targetoid

*not typically vesicular or bullous

67
Q

Extremity changes in Kawasaki’s disease

A
  • swelling of hands and feet
  • diffuse erythema on palms and soles
  • arthritis in large joints
  • sheet like desquamination that beings periungual (Beau’s lines)
68
Q

Lymphadenopathy in Kawasaki’s

A
  • primarily anterior cervical nodes
  • typically singular
  • typicall large >1.5cm
69
Q

Cardiovascular chages in Kawasaki’s disease

A

on day 5-10: tachycardia out of proportion to fever

  • muffled heart sounds
  • brachial aneurysms
  • cold pale cyanotic digits
70
Q

Later cardiovascular complications of Kawasaki’s disease

A
  • coronary artery aneurysm
  • myocarditis
  • pericarditis
  • MI
  • arrhythmias
71
Q

Labs that may occur in Kawasaki’s

A
  • elevated ESR adn CRP
  • elevated platelets
  • normocytic/normochromic anemia
  • elevated liver transminases
  • UA: pyuria without infections
72
Q

What does every patient diagnosed with Kawasaki’s disease get

A

Echo repeated in 4-6 weeks

73
Q

Treatment of Kawasaki’s disease

A
  • admit to hospital for monitoring
  • monitor specifically for cardiovascular function

IVIG–> reduce aneurysm risk
ASA
Steriods if IVIG fails twice
TNF inhb if IVIG fails twice

74
Q

When should you expect fever to drop after giving IVIG in KAwasaki’s

A

within 36hrs, give second dose if that does not happen

75
Q

Coxsackie aka

A

hand, foot, mouth

76
Q

What casues coxsackie

A

enterovirus

77
Q

How is coxsackie spread

A

fecal oral

78
Q

Most likely presentation of coxsackie

A
  • apthous stomatitis
  • rash on hands and feet
  • fever

*uncommonly causes aseptic meningitis

79
Q

Treatment of coxsackie

A

Symptomatically

  • tylenol or motrin
  • magic mouthwash (benadryl and maalox)
80
Q

Classic varicella

A

dew drop on a rose petal

81
Q

Chicken pox aka

A

initial varicella zoster virus

82
Q

Treatment of chicken pox

A

Symptomatic

  • motrin or tylenol
  • benadryl or aveeno

if pt is high risk–> acyclovir, valcyclovir

83
Q

Rare complications of chicken pox

A
  • encephalitis
  • pneumonia
  • bronchitis
  • post herpetic neuralgia
84
Q

Eneuresis

A

involuntary urination

85
Q

Treatment of nocturnal eneuresis

A

DDVAP–> increases ADH–> decrease urine output

86
Q

Causes of UTI in infants

A

-anatomical abnormalities: vesicoureteric reflux

think UUTI if URI sxs w/ fever and <3months that is not present with dysuria, hematuria, frequency

87
Q

Causes of UTI in children

A
  • toilet trainign and poor wiping
  • constipation
  • withholding
88
Q

Causes of UTI in teens

A

-STI or sexually related until proven other wise

Clin Med IV Exam III (8 decks)

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