Outpatient Peds stuff Flashcards
What is the Cobb angle?
The Cobb angle is formed by the intersection of a line parallel to the superior endplate of the most superior vertebrae in a curve with a line parallel to the inferior endplate of the most inferior vertebrae in a curve. The intersection is often outside the borders of the actual film, so perpendicular lines are drawn from these parallel lines, and the angle between the intersection is measured. A curve is considered mild if the Cobb angle is between 5-15 degrees, moderate if between 20-45 degrees, and severe if greater than 50 degrees.
What is the presentation, causative agent, clinical course, diagnosis and treatment for hand foot and mouth disease
vesicles found on the hands, feet, and mouth associated with constitutional symptoms. This is consistent with hand, foot, and mouth disease (HFMD), which is a clinical syndrome most commonly caused by species of the genus enterovirus, particularly coxsackievirus A16 and enterovirus A71. The syndrome is characterized by an oral enanthem in addition to an erythematous, macular, and/or a vesicular rash that occurs on the palms, soles, and sometimes other parts of the body. The virus may be spread via fecal contact, vesicle fluid, or via respiratory secretions, and occurs most commonly in children under the age of 7, particularly those attending day-care or school. The incubation period is typically 3-5 days and the infectious period is about 7-10 days except in atypical cases.
The most common presentation of individuals with HFMD begins with complaints of a sore throat or dysphagia which may be followed by a low-grade fever (less than 101ºF). This is followed by the classical oral enanthem that consists of oral lesions that may appear on the tongue, buccal mucosa, the palates, uvula or tonsils. It begins as erythematous macules which evolve into vesicles. The exanthem may appear most commonly on the hands and feet, but also on the buttock, upper legs, and arms as a macular, maculopapular or vesicular rash.
As seen in the scenario, the location and type of lesions may vary from case to case, and patients may present with different lesions in different locations, as this patient has vesicles on the hands and macules on the feet. Additionally, while nearly 75% of patients have both, the enanthem may occur without the exanthem and vice versa. These lesions are typically not painful nor pruritic and resolve within 3-4 days, and the total disease course typically lasts 7-10 days.
Diagnosis is made clinically based on the evaluation of lesions without necessity for lab testing; however, if needed, PCR is the preferred testing method. Some serotypes, such as enterovirus A71 and coxsackievirus A6, may present with more severe features, including higher fever, larger distribution of exanthem, and potential effects on the neurologic and cardiac systems such as aseptic meningitis, flaccid paralysis, or myocarditis, and heart failure. Ultimately, in non-severe cases, treatment involves supportive care including adequate hydration and treatment of pain and fever. Prevention is the most important part of limiting the disease, and consists of a strong focus on strict adherence to hygiene, specifically in child care settings.
What is the virus for Chickenpox, viral presentation?
Chickenpox
Varicella-Zoster
Prodrome of fever and malaise that presents as multiple pruritic lesions consisting of macules, papules, vesicles, and crusts which begins on the trunk and spreads to the face and limbs
What is the virus for Roseola Infantum, clinical picture?
Roseola Infantum
Herpesvirus 6
Spiking fever that drops as a rash appears, consisting of erythematous macules primarily on the neck and trunk
What is the virus and clinical picture associated with Rubella?
Rubella
Rubella virus
Pink macules and papules spreading on the whole body surface sometimes associated with posterior cervical lymphadenopathy
What is the cause of measles? clinical picture?
Measles Measles virus (Paramyxovirus) Prodrome of cough, coryza, conjunctivitis. Exanthem with erythematous, raised papules spreading from neck and face to body and limbs
What is the cause of Fifth’s disease? clinical picture?
Fifth Disease
Parvovirus B19
Prodrome of fever, headache cough. Erythema infectiosum exanthem appearing on the face with a maculopapular, reticular pattern reminiscent of a slapped cheek
What is Radial head subluxation? how do we treat this?
radial head subluxation (RHS), also called “nursemaid’s elbow,” “pulled elbow,” or “annular ligament displacement.” Radial head subluxation is a clinical diagnosis, and radiologic investigation is usually unnecessary prior to proceeding with reduction. If there is a classic history, the child is 5 years old or younger, and the clinical examination is strongly supportive of RHS, plain radiographs should be avoided. Most children with suspected RHS who undergo radiography do not have a fracture. Studies have shown that radiographs in children with radial head subluxation almost always show normal anatomy.
The mechanism of injury in RHS is longitudinal, axial traction on a pronated forearm with the elbow in extension, as seen in this patient. With sudden pulling on the distal radius, a portion of the annular ligament slips over the head of the radius and slides into the radiohumeral joint, where it becomes trapped. The classic mechanism for RHS consists of a “pull injury” when a parent or caregiver grabs the arm to prevent the child from falling or pulling away. RHS is a frequent elbow injury in young children, with a male-to-female ratio of 1:2. It typically occurs between the ages of one and four years since after age five years, the distal attachment of the annular ligament to the neck of the radius strengthens significantly to prevent tearing or subsequent displacement. RHS occurs in the left elbow 70% of the time.
Studies have shown that the hyperpronation method is associated with a higher rate of successful radial head subluxation reduction than the supination/flexion method. The available data suggest that hyperpronation is more likely to be successful on the first or second attempt and is perhaps less painful. In the hyperpronation method, the examiner flexes the elbow to 90 degrees, supporting the child’s arm at the elbow and placing moderate pressure on the radial head with one finger. The examiner grips the child’s distal forearm with the other hand and hyperpronates the forearm. A click may be felt by the finger over the radial head when the subluxation is reduced. In the supination/flexion technique, the examiner supports the child’s arm at the elbow and exerts moderate pressure on the radial head with the thumb or one finger. With the other hand, the examiner holds the child’s distal forearm and then pulls with gentle traction. While maintaining traction, the examiner fully supinates the child’s forearm and then fully flexes the elbow in one smooth motion. A click may be felt by the finger over the radial head or a pop may be heard by the examiner when the subluxation is reduced.
When can kids start and adult diet?
Most children can start eating an adult diet at 2 years old. This means that they can eat the same foods as the older members of the family. At this age they will still require supervision from an adult. Food will also need to be modified to ensure that it is a safe size and not a choking hazard. Children at this age cannot eat small, round, hard foods. Things such as nuts and pop-corn should be avoided as they cannot safely be modified. Sticky foods such as peanut butter and marshmallows should also be avoided except in very small portion sizes. Soft round foods, such as grapes and hot dogs, can be modified by cutting them so that they are no longer round. Foods such as meats, rice, potatoes, and cut up vegetables are great for children of this age group as long as they are cut into small enough pieces that the child can safely chew it. Children will also require a smaller serving size based upon their own nutritional needs.
First line treatments for Otitis Media?
First-Line Amoxicillin IF recent antibiotic use, purulent conjunctivitis, or recurrent otitis media: Amoxicillin-Clavulanate Penicillin Allergy Mild Allergy Cefdinir Cefpodoxime Cefuroxime Ceftriaxone Severe Allergy Azithromycin Clarithromycin
Discuss Atopic dermatitis in kids
The patient is suffering from atopic dermatitis (AD), which is also known as eczema and is a chronic, inflammatory skin disorder characterized by pruritus leading to lichenification (i.e., thickening of the skin with accentuated skin markings). AD is commonly called the “itch that rashes.” During infancy, it presents on the face with paranasal and periorbital sparing. In children, it usually presents on flexor surfaces. In adults, the most common affected sites are the hands, nipples, and eyelids. It is also associated with allergic rhinitis and asthma. Dennie-Morgan lines are edema of the skin of the lower eyelids caused by AD, allergic rhinitis, or both. AD is usually treated by a short course (i.e., two to three weeks) of midpotency steroid creams until initial inflammation subsides. Maintaining the skin barrier is a very important part of the treatment plan for these patients and involves the use of nondrying soaps and moisturizers, and the avoidance of triggers, such as decreased humidity, excessive washing, and sudden temperature changes. Severe AD can be managed with other medications, such as cyclosporine.
What is a SCFE?
This patient’s clinical presentation is consistent with slipped capital femoral epiphysis (SCFE). SCFE is a rare disease in which there is instability at the proximal femoral growth plate, causing the femoral head to be displaced posteriorly and inferiorly. An x-ray of the hip is the most appropriate first step in diagnosis. In this case, the patient presented with knee pain also. Thus, an x-ray of the knee would be appropriate. SCFE commonly occurs in children age 10 to 16 years and is twice as common in boys than in girls. It has a high predominance in obese children. Treatment includes surgical pinning of the femoral head.
Slipped capital femoral epiphysis (SCFE) is associated with avascular necrosis of the femoral head. Slippage of the femoral head causes compromise to the vascular supply. Necrosis occurs at a rate of 7.5% within the first 24 hours. It increases to greater than 75% after 48 hours. Therefore, consultation with an orthopedic surgeon is emergent.
Treatment of Duchenne Muscular Dystrophy?
Duchenne muscular dystrophy (DMD). The mainstay of pharmacologic treatment for DMD is glucocorticoids.
Milestones 2 months, 4-5 months, 1 year, 2 years, 3 years, 4 years?
2 months: Lifts head/chest when prone, tracks past midline, alert to sound, coos, recognizes parent, and social smiles
4-5 months: Rolls front to back and back to front, grasps rattle, orients to voice, enjoys looking around, and laughs
12 months, an infant is able to cruise and walk alone, uses 2-finger pincer grasp, can say mama/dada specifically, and imitates actions.
2 years: Walks up/down steps with help, jumps, builds tower of 6 cubes, uses 2-word phrases, follows 2-step commands, and removes clothes
3 years: Rides tricycle, climbs stairs with alternating feet (3-4 years), copies a circle, uses utensils, uses 3-word sentences, brushes teeth with help, and washes/dries hands
4 years: Hops, copies a cross, counts to 10, and cooperatively plays
4 year old vaccines?
The 4-year-old well child visit should involve 4 vaccinations if the child is already up to date. These vaccinations include:
Measles, mumps, and rubella
Varicella
IPV (polio)
Dtap (diphtheria, tetanus, and pertussis)
4 year old milestones?
A 4-year-old patient reaches many new milestones that you should be asking about. Some of them are listed below:
They should be able to recite their full name
They like to play with other children
They can sing a song like “itsy bitsy spider” by themself
They can draw a person with 2-4 body parts
They can begin to hop and stand on one leg for short periods of time
They can catch a bounced ball most of the time
They can play board or card games
