Misc Peds Lecture Flashcards
What is strabismus
a anomaly of ocular alignment that can be unilateral or bilateral
Types of strabismus
eso—> nasal
exo—> temporal
latent=phoria
manifest= tropia
Risk factors for primary strabismus
- family hx
- low birth weight
- muscle abnormality
- visual deprivation
Complications of strabismus
- amblyopia
- diplopia
- contracture of extraoccular muscles
- psychosocial and vocational consequences
Treatment of strabismus
medial:
- glasses
- miotic drops
- patching
- visual training exercises
Surgical:
-repositioning or shortening
Impetigo
contagious superficial bacterial infection
Primary vs secondary impetigo
primary- direct bacterial invasion of normal skin (pyoderma)
secondary- infection at site with previous mild trauma (impetigo contagiosa)
Who gets impetigo
- kids 2 to 5 years old
- warm, humid conditions
- spread easily by close contacts
What causes impetigo
staph
What are the three types of impetigo
- non bullous
- bullous
- ecthyma
Non bullous impetigo
vesicles surrounded by erythema and breakdown and become thick adherent crust with “honey colored” appearance
Bullous impetigo
vesicles enlarge to form flaccid bullae with clear yellow fluid which becomes darker and ruptures to form thin brown crust
Ecthyma
ulcerative form of impetigo, causes punched out ulcers w/ yellow crust that is surrounded by raised margins
When do you culture fluid from impetigo
if treatment fails
Topical treatment for impetigo
- mupirocin
- h2O2 cream
Oral treatment of impetigo
use if bullae
- diclox
- cephalexin
- clinda
- bactrim if MRSA suspected
Appearance of pin worms
small white and threadlike
Where do pinworms inhabit
- cecum
- appendix
- ileum
- ascending colon
Pinworms aka ____ caused by ___
eterobiasis caused by enterobius vermicularis
Spread of pinworms
fecal or oral route
Clinical manifestations of pinworms
- nocturnal perianal and perineal itching
- visible worms around anus and buttocks
Diagnosis of pinworms
- hx of nocturnal itching
- collection with cellophane tape or pinworm paddle
- visual inspection of stool or anus
Treatment for pinworms
- Albendazole: 400mg once and repeat in 2 weeks
- pyrantel pamoate is alternative
- treat family
- practice good hygiene
erythema infectiousum aka
fifth disease
What causes erythema infectiousum
parovirus B19
How if erythema infectiousum transmitted
UNKNOWN
-transmission stops after symptoms develop
Symptoms of erythema infectiousum
Day 1-2: fever, headache, nausea, diarrhea
Day 2-5: slapped cheeks, circumoral pallor, reticulated rash on trunk/extremities
What things can make the rash in fifth disease reappear
- sunlight
- heat changes
- exercise
- stress
Treatment of erythema infectiousum
Supportive only
What can parvovirus B19 cause in adults
- transient aplastic crisis
- fetal hydrops–> fetal demise
- arthritis/arthralgia
- chronic symptoms
Cause of mono
EBV
Transmission of mono
- virus shed in salivary secretions
- found but not transmitted in breast milk
- ? sexually transmitted
Incubation of mono
4-7 weeks
Classic clinical manifestation of mono
- fever
- pharyngitis
- adenopathy
- fatigue
- atypical lymphocytosis
- splenomegaly
- rash
- hepatitis
Less common symptoms of mono
- splenic rupture
- guillain barre, CN palsies, aseptic meningitis, transverse myelitis, optic neuritis
- cholestasis
- pneumonia
- myocarditis
- pancreatitis
- mesenteric adenitis
Diagnosing mono?
- mostly a clinical diagnosis
- atypical lymphocytes >10% on diff
- heterophile Ab (monospot)
What things can turn monospot positive other than mono
- leukemia
- lymphoma
- pancreatic cancer
When should you consider an EBV panel
if a pt has sx and findings c/w mono and the heterophile remains negative after retesting 1 week later
What should you consider in EBV panel is negative
- CMV
- HIV
- Toxo
- HHV 6 or 7
- Hep B
Treatment of mono
- supportive care (hydration, antipyretics)
- steriods if airway compromised by tonsillar hypertrophy
- splenic rupture precautions
What are splenic rupture precautions
- 3 weeks mild activity
- minimum 4 weeks for contact/high risk sports and activities
- or longer if spleen remains enlarged by palpation or ultrasound
Symptoms of measles
- fever
- cough
- coryza
- conjunctivitis
Pathognomonic for measles
Koplik spots
-maculopapular rash that start at head
When is measles contagious
4 days before rash through 4 days after rash
Common complications of measles
- OM
- pneumonia/bronchopneumonia
- croup
- diarrhea
Less common complications of measles
- acute encephalitis
- respiratory or neuro complication
- subacute sclerosing panencephalitis (occurs 7-10 years later)
How are the measles spread
- highly contagious
- direct contacts with droplets or airborne
- remains on surfaces for up to 2 hours
Testing for measles
-IgM antibody
-RNA by PCR
via serum or NP swab
can also get urine
Poster exposure prophylaxis for measles
-MMR vaccine withing 72 hours of exposure or IG if administered within 6 days of exposure
Treatment of severe measles in children (hospitilized). Why?
Vitamin A
- deficiency contributes to delayed recovery and to the high rate of post measles complications
- can also cause xerophthalmia–> childhood blindness
Rubella aka
german measles
Symptoms of rubella
- rash and low grade fever
- lymphadenopathy and arthralgia in older kids and adults
Complications of rubella
birth defects in pregnant women–> deafness, cataracts, heart defects, developmental delay, liver and spleen damage
How is rubella transmitted
airborne
Roseola is caused by what
HHV 6 and HHV 7
Signs and symptoms of roseola
- sudden high fever (102-104)
- fever subsides and rash appears
- rash trunk to arms and legs
- rash is asymptomatic
Kawaskai’s disease is also know as what
Mucocutaneous lymph node syndrome
What is Kawaskai’s disease
widespread inflammation of medium sized blood vessels throughout the body
most importantly vessels of heart
Who gets Kawaskai’s disease
- kids less than 5
- boys more than girls
What causes Kawasaki’s disease?
mainly unknown
- possible infectious (winter and summer)
- possibly genetic (asain and asain american)
What is seen in vessel walls in Kawasaki’s disease
neutrophilic inflitrate
*polymorphocytes then macrophages and lymphocytes
Clinical manifestations of Kawasaki’s disease
- fever
- conjunctivitis
- mucositis
- rash
- extremity changes
- lymphadenopathy
- cardiovascular findings
Fever in Kawasaki’s disease
fever over 100.5 lasting 5 days or longer
*kids with a fever for 5 days or longer with no obvious source think Kawasaki
Conjunctivitis in Kawasaki’s disease
- non exudative
- bilateral
- spares the limbus
can be accompanied by photophobia/uveitis
Mucositis in Kawasaki’s disease
- crack red lips
- strawberry tongue
*not associated with tonsillar exudate, oral vesicles or ulcers
Rash with Kawasaki’s disease
- polymorphous
- begins perineal with erythema with desquamations
- then may be macular/morbilliform/targetoid
*not typically vesicular or bullous
Extremity changes in Kawasaki’s disease
- swelling of hands and feet
- diffuse erythema on palms and soles
- arthritis in large joints
- sheet like desquamination that beings periungual (Beau’s lines)
Lymphadenopathy in Kawasaki’s
- primarily anterior cervical nodes
- typically singular
- typicall large >1.5cm
Cardiovascular chages in Kawasaki’s disease
on day 5-10: tachycardia out of proportion to fever
- muffled heart sounds
- brachial aneurysms
- cold pale cyanotic digits
Later cardiovascular complications of Kawasaki’s disease
- coronary artery aneurysm
- myocarditis
- pericarditis
- MI
- arrhythmias
Labs that may occur in Kawasaki’s
- elevated ESR adn CRP
- elevated platelets
- normocytic/normochromic anemia
- elevated liver transminases
- UA: pyuria without infections
What does every patient diagnosed with Kawasaki’s disease get
Echo repeated in 4-6 weeks
Treatment of Kawasaki’s disease
- 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
When should you expect fever to drop after giving IVIG in KAwasaki’s
within 36hrs, give second dose if that does not happen
Coxsackie aka
hand, foot, mouth
What casues coxsackie
enterovirus
How is coxsackie spread
fecal oral
Most likely presentation of coxsackie
- apthous stomatitis
- rash on hands and feet
- fever
*uncommonly causes aseptic meningitis
Treatment of coxsackie
Symptomatically
- tylenol or motrin
- magic mouthwash (benadryl and maalox)
Classic varicella
dew drop on a rose petal
Chicken pox aka
initial varicella zoster virus
Treatment of chicken pox
Symptomatic
- motrin or tylenol
- benadryl or aveeno
if pt is high risk–> acyclovir, valcyclovir
Rare complications of chicken pox
- encephalitis
- pneumonia
- bronchitis
- post herpetic neuralgia
Eneuresis
involuntary urination
Treatment of nocturnal eneuresis
DDVAP–> increases ADH–> decrease urine output
Causes of UTI in infants
-anatomical abnormalities: vesicoureteric reflux
think UUTI if URI sxs w/ fever and <3months that is not present with dysuria, hematuria, frequency
Causes of UTI in children
- toilet trainign and poor wiping
- constipation
- withholding
Causes of UTI in teens
-STI or sexually related until proven other wise
