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Pediatrics EOR > Part 1 > Flashcards

Part 1 Flashcards

1
Q

what are epstein pearls

A

intraoral epidermal cysts filled with keratinous material often seen in newborns, will spontaneously rupture

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2
Q

when does neonatal acne occur

A

usually 2-4 weeks old, then resolve spontaneously over 6 months - 1 year

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3
Q

when do cafe au lait macules raise concern in pre-pubertal children and what do they raise concern for

A

6 or more spots over 0.5 cm in diameter (1.5 cm in post-pubertal adolescent) raise concern for neurofibromatosis 1

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4
Q

treatment of choice for infantile hemangiomas

A

propranolol or systemic prednisolone

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5
Q

acne pathophysiology

A

obstruction of sebaceous follicle and increased sebum production leading to proliferation of bacteria in the obstructed follicle and inflammation, often androgen-mediated

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6
Q

what drugs can cause drug-induced acne

A

ACTH, glucocorticoids, androgens, hydantoins, INH (all increase plasma testosterone)

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7
Q

what are open comedones

A

“blackheads” oxidized melanin within stratum corneum plug. Predominant lesion in early adolescent acne

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8
Q

what are closed comedones

A

“whiteheads” obstruction just beneath follicular opening in sebaceous follicle, producing a cystic swelling of follicular duct

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9
Q

1st line treatment for adolescent acne

A

topical retinoid

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10
Q

topical retinoid examples

A

tretinoin, adapalene, tazarotene

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11
Q

topical retinoid MOA

A

keratolytic agents that prevent plugging of the follicular opening

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12
Q

how to use topical retinoid

A

once daily OR once in the evening plus application of benzoyl peroxide or azelaic acid in the morning

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13
Q

what topical antibiotic may be used for acne and how should it be used

A

1% clindamycin phosphate, always use with benzoyl peroxide or a retinoid. Often come in combination preparations

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14
Q

PO tx for moderate to severe inflammatory acne

A

antibiotics that concentrate in sebum: tetracycline, minocycline, doxycycline

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15
Q

tetracycline dose for acne

A

0.5-1.0 g divided twice a day on an empty stomach

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16
Q

minocycline, doxycycline dose for acne

A

50-100 mg taken qd or bid +/- food

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17
Q

considerations for oral abx for acne

A

should always be used with retinoid and/or benzoyl peroxide, should always stop taking them after inflammatory lesions improve, don’t give tetracyclines to kids <8 y/o

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18
Q

doxycycline major side effect

A

photosensitivity

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19
Q

minocycline side effects

A

bluish gray skin discoloration, vertigo, headaches, drug-induced lupus

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20
Q

most effect treatment for severe cystic acne

A

isotretinoin (PO retinoid)

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21
Q

initial dosage for isotrentinoin

A

0.5-1 mg/kg/day

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22
Q

isotretinoin side effects

A

dryness/scaling of skin, dry lips, dry eyes/nose, muscle aches with athletics, mild and reversible hair loss, acute depression/mood changes, teratogen

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23
Q

Consideration of prescribing isotretinoin

A

must register with FDA via iPLEDGE

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24
Q

treatments for hormonal acne in females

A

OCPs, spironolactone

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25
Q

what should always be prescribed with isotretinoin in females in the absence of contraindications

A

OCPs

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26
Q

pathogens causing impetigo

A

staph aureus (most common) and group A strep

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27
Q

what is impetigo

A

superficial invasion of bacteria into upper epidermis, forming a subcorneal pustule

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28
Q

impetigo presentation

A

papules and vesicles becoming erosions covered by honey-colored crusts usually without systemic symptoms, usually affecting the face and extremities. May have flaccid bullae in bullous impetigo

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29
Q

most common age for impetigo

A

2-5 y/o

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30
Q

what causes bullous impetigo

A

strains of staph aureus that produce exfoliative toxin A

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31
Q

postinfectious sequelae of impetigo

A

poststreptococcal glomerulonephritis (edema, HTN, fever, hematuria)

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32
Q

treatment for impetigo with limited skin involvement

A

topical mupirocin tid or retapamulin bid x 5 days

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33
Q

treatment of extensive impetigo

A

Most cases: PO Cephalexin, dicloxacillin.
If PCN/cephalosporin allergy: Erythromycin or clarithromycin
If MRSA potential: Doxycycline or bactrim or clindamycin
All PO abx tx are for 7 days. Current recommends that all peds be given PO treatment over topical to eradicate nasal colonization

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34
Q

when can kids with impetigo return to school

A

24 hours after beginning abx, with draining lesions kept covered

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35
Q

what is the Nikolsky sign

A

slightest pressure on skin causes separation of the epidermis

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36
Q

tinea capitis ssx

A

thickened, broken-off hairs (“black dot” appearance on scalp) with erythema and scaling of underlying scalp

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37
Q

pathogens in tinea capitis

A

trichophyton tonsurans, microsporum canis

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38
Q

tinea corporis ssx

A

annular, marginated plaques with thin scale at periphery and clear center or annular confluent dermatitis

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39
Q

what is a kerion

A

boggy, fluctuant mass on the scalp caused by an exaggerated host response in tinea capitis

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40
Q

tinea diagnosis

A

scrape scale from the border of the lesion, dissolve them in 20% KOH, and examine for hyphae

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41
Q

tinea cruris ssx

A

symmetrical, sharply marginated lesions in inguinal areas

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42
Q

tinea pedis ssx

A

red scaly soles, blisters on foot instep, fissuring between toes

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43
Q

onychomycosis aka

A

tinea unguium

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44
Q

onychomycosis ssx

A

loosening of the nail plate from the nail bed, giving a yellow discoloration. Also thickening of distal nail plate and scaling and crumbling of nail plate surface. Affects usually only 1-2 nails

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45
Q

tinea capitis tx

A

PO griseofulvin or terbinafine with cultures taken q 4 weeks and tx continued for 4 weeks after a negative culture

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46
Q

onychomycosis tx

A

topical ciclopirox but has low success rate. PO terbinafine x 6-12 weeks or pulsed-dose itraconazole given in 3 1-week pulses separated by 3 weeks

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47
Q

tinea corprois/pedis/cruris tx

A

topicaL -azoles, terbinafine, butenafine, ciclopirox bid x 3-4 weeks

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48
Q

what is tinea versicolor

A

superficial infection caused by malassezia, a yeast-like fungus

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49
Q

tinea versicolor ssx

A

polycyclic connected hypopigmented macules and very fine scale in areas of sun-induced pigmentations

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50
Q

tinea versicolor tx

A

selenium sulfide 2.5% or zinc pyrithione shampoo applied to whole body and left on overnight, repeat in 1 week and monthly thereafter.
OR topical antifungals bid 1-2 weeks
OR fluconazole 1 dose PO

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51
Q

what type of cardiac shunt causes cyanosis

A

right to left

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52
Q

scabies ssx

A

linear burrows in wrists, ankles, finger webs, areolas, axillary folds, genitals, face. With excoriations and signs of secondary infection (honey colored crusts, pustules)

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53
Q

scabies diagnosis

A

ID of female mite, eggs, feces via microscopic examination of scraping of an unscratched burrow

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54
Q

scabies treatment

A

permethrin 5% as a single overnight application and repeated in 7 days including household contacts. For resistant cases, PO ivermectin x 1 and repeated in 7 days

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55
Q

lice ssx

A

excoriated papules and pustules and severe itching at night

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56
Q

lice treatment

A

OTC pyrethrin or permethrin with removal of nits with lice comb, 2 applications 7 days apart. If this doesn’t work, malathion 0.5% with a second treatment 7 days later if necessary. Can also try topical ivermectin and spinosad

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57
Q

atopic dermatitis clinical features

A

pruritus plus at least 3 of the following: generalized dry skin in the past 12 months, history of allergic rhinitis or asthma, onset before 2 y/o, skin crease involvement, flexural dermatitis

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58
Q

3 clinical phases of atopic dermatitis

A
  1. infantile eczema
  2. childhood/flexural eczema
  3. adolescent eczema
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59
Q

infantile eczema ssx

A

begins on cheeks and scalp, then oval patches on trunk, then extensor surfaces of extremities. Onset of 2-3 months, ending at age 18 months

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60
Q

childhood/adolescent eczema ssx

A

2 y/o to adolescence, flexural surfaces including antecubital and popliteal fossa, neck, wrists, hands/feet

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61
Q

atopic dermatitis complications

A

faulty epidermal barrier leads to dry, itchy skin, cracks in epidermis, secondary infections with staph/strep/HSV

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62
Q

atopic dermatitis acute stages (weeping) tx

A

wed dressings and medium potency topical corticosteroids with systemic tx of superinfection if necessary

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63
Q

atopic dermatitis chronic stages tx

A

avoid irritants and restore moisture to skin (moisturizer, humidifiers, minimize bathing and harsh soaps), medium strength corticosteroids when necessary

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64
Q

examples of medium potency corticosteroids

A

hydrocortisone, triamcinolone, fluocinolone, mometasone

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65
Q

2nd line treatment for atopic dermatitis (after medium-potency steroids) and dosing considerations

A

tacrolimus, pimecrolimus: only >2y/o

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66
Q

systemic immunosuppresants for severe atopic dermatitis

A

methotrexate, cyclosporine, azathioprine

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67
Q

ASD clinical CV exam findings

A

fixed, widely split S2, RV heave.
Systolic ejection murmur at pulmonic listening point.
May have diastolic flow murmur at LLSB

68
Q

ASD ECG findings

A

rsR’ in V1, right axis deviation

69
Q

most common form of ASD

A

ostium secundum

70
Q

Ostium secundum ASD is more likely in ____ and is usually ______

A

females, sporadic

71
Q

what is Eisenmenger syndrome

A

when an acyanotic (L to R) shunt causes so much right-sided congestion (pulmonary HTN, RVH) that the shunt reverses and becomes R to L, causing cyanosis

72
Q

R to L cardiac shunts are ____

A

cyanotic

73
Q

ASD ssx

A

infants and children are generally asymptomatic, older children and adults can have exercise intolerance, fatigability

74
Q

what causes the murmur in ASD

A

increased flow across the pulmonic valve

75
Q

ASD radiograph findings

A

cardiac enlargement, dilated pulmonary artery, increased pulmonary vascular markings

76
Q

ASD echo findings

A

dilated right atrium and RV with L to R shunt on color-flow doppler (diagnostic for ASD)

77
Q

ostium secundum ASD tx

A

transcatheter closure for symptomatic ASDs with right heart dilation, or elective closure at age 1-3 for asymptomatic

78
Q

what is the most common congenital heart malformation

A

VSD

79
Q

most common prognosis for VSD

A

usually < 3mm and will close spontaneously by 6 y/o, with muscular VSDs closing sooner than membranous ones

80
Q

what to do about moderate VSDs (3-5 mm)

A

they can be monitored serially, some will spontaneously close

81
Q

what to do about large VSDs

A

6-10 mm, will decrease in size but still likely require surgery, ideally before age 2

82
Q

large VSD ssx

A

failure to thrive, frequent respiratory infections, tachypnea, diaphoresis with feeds by age 3-6 months. Later, Eisenmenger syndrome and cyanosis occur

83
Q

what happens if large VSDs are not corrected

A

they may progress to irreversible pulmonary HTN

84
Q

small left to right shunt exam findings in VSD

A

no lifts, heaves, or thrills. Physiologic splitting of S2. Harsh, pansystolic murmur best heart at LSB that radiates over entire precordium

85
Q

Moderate L to R shunt VSD exam findings

A

moderate LV heave, systolic thrill, splint S2, hash pansystolic murmur best heard at LLSB in 4th interspace. Mitral diastolic flow murmur indicates increased pulmonary venous return

86
Q

CXR VSD

A

small: normal. Large: cardiac enlargement involving both LV and RV and left atrium, with dilated pulmonary artery segment and increased pulmonary vascular markings

87
Q

large VSD exam findings

A

sternum bulges, palpable LV and RV heaves, thrill at lower left sternal border, harsh pansystolic murmur that may decrease as the defect is large and ventricular pressures equalize.

88
Q

VSD ECG findings

A

normal in small shunts.
LVH
or LVH plus RVH if pulmonary HTN
or RVH in pulmonary HTN secondary to vascular obstruction by eisenmengersyndrome

89
Q

diagnosis of VSD

A

Echo

90
Q

VSD treatment

A

medical: diuretics, systemic afterload reduction
Surgery: age 3-6 months, transcatheter

91
Q

murmur of PDA

A

continuous, machinery-type

92
Q

what is a PDA

A

persistence of normal fetal vessel joining pulmonary artery to aorta

93
Q

when does ductus arteriosus normally close

A

1-5 days of age

94
Q

what maintains ductus arteriosus patency

A

prostaglandin E2

95
Q

moderate-large PDA ssx

A

bounding pulses, wide pulse pressure, +/- paradoxical splitting of S2

96
Q

what is paradoxical S2 splitting

A

S2 narrows on inspiration and widens on expiration, caused by LV volume overload

97
Q

PDA treatment when is it indicated

A

PDA is large and patient is small (ideally less than 1 y/o)

98
Q

PDA treatment

A

safety coil or device-occluded in the cath lab

99
Q

what drug is used to close the PDA in preterm infants

A

indomethacin

100
Q

essential features of coarctation of aorta

A

absent/diminished femoral pulses, upper to lower extremity SBP gradient, blowing systolic murmur in back or left axilla

101
Q

most common location of coarctation

A

proximal descending aorta at the insertion of the ductus arteriosus, just distal to the takeoff of the left subclavian artery

102
Q

Coarctation is more common in ____ and in females is associated with _____

A

males, turner syndrome

103
Q

coarctation is associated with what conditions

A

berry aneurysm, bicuspid aortic valve

104
Q

what is true of lower extremity pulses in coarctation

A

may be normal until ductus arteriosus closes

105
Q

2 types of presentation with coarctation

A
  1. neonatal acute LV dysfunction, shock, acidosis when the PDA closes
  2. Delayed presentation as a child or young adult with systemic HTN, claudication, failure to thrive
106
Q

coarctation CXR

A

cardiac enlargement, pulmonary venous congestion, rib notching, figure 3 sign (prominent aorta proximal to coarctation, dilation distal to the coarctation, indentation at the coarctation)

107
Q

ECG in coarctation

A

often normal in neonates, LVH in older kids

108
Q

primary resuscitation measure in neonates with coarctation

A

PGE1 infusion to reopen the ductus arteriosus, inotropic support followed by corrective surgical repair

109
Q

treatment of coarctation in older kids

A

balloon angioplasty, stenting

110
Q

coarctation prognosis

A

for those who survive neonatal period, HTN is common, infective endarteritis in adolescents

111
Q

most common cyanotic cardiac lesion

A

tetralogy of fallot

112
Q

what is tetralogy of fallot

A

anterior deviation of infundibulum causes narrowing of RV outflow tract, VSD, and overriding aorta. This leads to RVH

113
Q

T of F is associated with

A

chromosome 22 deletion syndromes like DiGeorge syndrome

114
Q

what dictates the severity of symptoms in T of F

A

degree of RV outflow obstruction

115
Q

T of F ssx

A

progressive cyanosis with easy fatigability and dyspnea on exertion, +/-clubbing. Ssx improve with squatting

116
Q

what is a tet spell

A

cyanosis/dyspnea/AMS/decrease of murmur with crying, feeding or exercise

117
Q

when do tet spells usually start

A

4-6 months

118
Q

acute tx of tet spells

A

O2, knee-to-chest position, consider morphine and propanolol

119
Q

prevention of tet spells

A

PO propranolol, but usually needs surgery

120
Q

when is T of F usually repaired

A

around 3 months old

121
Q

CV exam findings in T of F

A

palpable RV lift, single S2, rough/systolic ejection murmur radiating to the back at the left sternal border in the 3rd intercostal space

122
Q

CXR T of F

A

RVH, boot-shaped heart, decreased pulmonary vascular markings

123
Q

T of F EKG

A

right axis deviation with RVH

124
Q

what infection precedes rheumatic fever

A

group A strep

125
Q

major criteria for rheumatic fever

A

carditis, arthritis, chorea, erythema marginatum, subcutaneous nodules

126
Q

minor criteria for rheumatic fever

A

arthralgia, fever > 38.5, elevated inflammatory markers, prolonged PR interval

127
Q

diagnosis of initial acute rheumatic fever

A

2 majors or one major and 2 minors

128
Q

diagnosis of recurrent acute rheumatic fever

A

2 major or one major and two minor or three minor

129
Q

pathophys of rheumatic fever

A

sensitization of B lymphocytes by strep antigens causes formation of anti-strep antibody complexes that cross-react with cardiac sarcolemma antigens, with associated myocardial and valvular inflammatory response

130
Q

what is the name of the rheumatic fever criteria

A

Jones criteria

131
Q

lab test that is seen in high levels with rheumatic fever

A

antistreptolysin O titer

132
Q

most commonly affected part of heart with rheumatic fever

A

mitral valve leading to mitral stenosis. Followed by aortic valve leading to aortic stenosis

133
Q

rheumatic fever arthritis characteristics

A

affects large joints, migratory

134
Q

type of chorea in rheumatic fever

A

sydenham chorea: involuntary and purposeless movements associated with emotional lability +/-ataxia, slurring of speech. Lasts 3 months but is self-limiting

135
Q

what is erythema marginatum

A

macular, serpiginous, erythematous rash with sharply demarcated border appearing primarily on trunk and extremities that spares the face

136
Q

treatment of acute rheumatic fever

A

PCN (2nd choice: narrow cephalosporins or clindamycin or azithromycin), 4 doses of ASA, HF tx (if HF present), ambulation as tolerated

137
Q

prevention of rheumatic fever recurrence

A

long-term prophylaxis with IM PCN q month or sulfadiazine of allergic to PCN or erythromycin if allergic to PCN and sulfa

138
Q

managing valve damage in rheumatic fever

A

valve replacement with abx prophylaxis if prosthetic valve is in place

139
Q

KD tx

A

IVIG, high dose ASA

140
Q

what is the leading cause of sudden cardiac death in young people

A

hypertrophic cardiomyopathy

141
Q

HCM ssx

A

may be asymptomatic or have angina, syncope, palpitations, exercise intolerance

142
Q

HCM physical exam findings

A

LV heave, S4 gallop, systolic ejection murmur if outflow tract obstruction present that is provoked by standing

143
Q

ECG findings in HCM

A

deep Q waves in II, III, aVF, V5, V6 with possible ST abnormalities in the same leads. LVH, LAH.

144
Q

what is associated with increased mortality in peds with HCM

A

extreme LVH and blunted blood pressure response to exervise

145
Q

HCM treatment

A

restriction from athletics, beta blockers/verapamil. If ssx still severe, surgical myomectomy, consider defibrillator placement

146
Q

syncope definition

A

transient LOC and postural tone due to abrupt, temporary decrease in cerebral blood flow

147
Q

elements of evaluation for syncope

A

ECG, personal/family history, physical exam

148
Q

syncope is rare before age ____

A

10

149
Q

concerning pattern of syncope requiring further workup

A

exertional syncope (requires echo and stress test)

150
Q

most common etiology of syncope in kids

A

vasovagal aka neurocardiogenic

151
Q

most common initiating event in vasovagal syncope

A

prolonged standing causing pooling in lower extremities

152
Q

vasovagal syncope ssx

A

Prodrome of nausea, abd pain, clammy sensation, dizziness, tunnel vision, weakness followed by short LOC (less than 2 mins) with rapid return to baseline, may have associated myoclonic jerks.

153
Q

vasovagal syncope prevention

A

adequate hydration, increased salt intake, initiation of maneuvers during prodrome such as squatting, leg crossing

154
Q

pharmacologic prevention options for vasovagal syncope

A

mineralocorticoids that increase intravascular volume such as fludrocortisone and midodrine, possibly beta blockers, vagolytic agents such as disopyramidem, SSRIs

155
Q

cause of diaper dermatitis

A

prolonged contact with urine and feces

156
Q

diaper dermatitis ssx

A

erythema and scaling of skin in perineal area with sparing of inguinal folds

157
Q

diaper dermatitis is associated with

A

c albicans

158
Q

when diaper dermatitis becomes colonized with c albicans, what is the presentation

A

beefy red, sharply marginated dermatitis with satellite lesions

159
Q

diaper dermatitis tx

A

frequent diaper changes with washing following bowel movement, air drying, application of barrier ointment such as zinc oxide with each diaper change. If c albicans is suspected, include imidazole cream bid

160
Q

pityriasis rosea presentation

A

pink/red oval plaques with fine scales in a christmas tree pattern with prodromal herald patch lasting 6-12 weeks

161
Q

pityriasis rosea tx

A

sunlight, antihistamines/topical steroids for pruritis

162
Q

erythema multiforme ssx

A

papules that later develop a dark center evolving into lesions with central bluish discoloration/blisters and iris lesions (3 concentric circles of color change)

163
Q

erythema multiforme is associated with

A

HSV, drugs (especially sulfanomides), mycoplasma

164
Q

erythema multiforme prognosis

A

healing occurs in 10-14 days

165
Q

erythema multiforme tx

A

removal of any offending drugs, PO antihistamines, cool compresses, acyclovir if associated with HSV

Pediatrics EOR (1 decks)

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