Pediatrics Flashcards
Hypertrophic cardiomyopathy
Sxs
- asx
- CP, syncope, palpitations, HF, SCD
Murmur: harsh crescendo-decrescendo systolic
- INC valsalva, squatting
- does not radiate to carotids
Dx: Echo, ECG, exercise test
Mgmt:
- avoid volume depletion
- Bblocker for children
- avoid vasodilators, diuretics, digoxin
- surgery
Avoid competitive sports
Eval q 6-12mo
Ventricular septal defect
** MC congenital heart defect
Small: asx
Large: CHF
Pulm vascular obstructive disease: pulm HTN and shunt reversal by 2nd decade of life
Acyanotic
Murmur: HOLOSYSTOLIC regurgitant LLSB murmur
Dx: echo bubble study
- Xray: increased pulmonary markings, cardiomegaly
Tx:
- spontaneous closure or surgery
Atrial septal defect
**2nd MC congenital defect
Murmur: Systolic Ejection at LUSB with Widely Split 2nd Heart Sound
Asx
- acyanotic
Dx:
- cardiomegaly
- increased pulm markings
Mgmt:
- Spontaneous closure by 1.5yo
- catheter closure
Patent ductus arteriosus
MC in preterm babies
Persistence of fetal ductus arteriosus connecting aorta to pulmonary artery
- typically closes 1-2nd day of life
Small: asx
Large: CHF
- bounding pulses = wide pulse pressure
- hyperactive precordium
Murmur: continuous machinery murmur @ ULSB or L infraclavicular area
Dx: ECG/CXR
Mgmt: Indomethacin* (premature infant)
- manage CHF w/digoxin/diuretics
- catheter closure, surgery
Coarctation of Aorta
A/w Turner syndrome and bicuspid aorta
Sxs:
- neonate w/CV collapse: ductal closure = acidosis, systemic organ failure
- infant w/CHF: dyspnea, diaphoresis, poor feeding, FTT
- child w/arterial HTN or heart murmur
- acyanotic lesion
Dx:
- difference in pulse/BP of UE vs. LE
- systolic LUSB
- CXR: inferior rib notching, figure 3 sign**
Mgmt:
- maintain ductal patency with prostaglandin* (alprostadil)
- surgical repair (<1yo)
- balloon dilation for recurrence
Tetralogy of Fallot
- MC cyanotic congenital heart disease
- VSD
- Overriding Aorta
- Pulmonary Stenosis
- RVH
- cyanosis, hypoxic spells
- tachypnea, nail clubbing
- DOE
“Tet Spell” - rapid deep breaths, irritability, crying, cyanosis, dec murmur
- mgmt: morphine, squat, correct acidosis, vasoconstrictors, propranolol
Murmur: early Systolic ejection murmur at LSB
Dx:
- Boot shaped heart* (CXR)
- Dec pulm vascular
Mgmt:
- full median sternotomy, CP bypass, R atriotomy (3-24 mo of age)
Acute Bronchiolitis
Et: RSV*
- kids <2y
Sxs:
- fever
- URI: tachypnea, retractions, expiratory wheezing*, cough, fever, otitis media
Dx:
- PE - look great but sound terrible
Mgmt:
- supportive care*: O2, fluids, nasal meds
- warm humidified high flow nasal cannula
- CPAP
- severe: racemic epi and admission
Admit: dehydration or pulse ox < 90%
Croup
Sxs
- prodrome: 1-5d of cough, coryza, fever
- 3-5d: “barking cough”** with inspiratory stridor
- worse w/crying, best w/cool air
Dx: CXR steeple sign
Mgmt:
- mild: reassurance*, humidifier, cool air
- mod/sev: nebulized racemic epi*, PO steroid w/2-4hr observation period
** MC cause of stridor
Et: parainfluenza virus
Pertussis
Et: bordetella pertussis
Sxs
- catarrhal: URI, most contagious*
- paroxysmal: staccato cough w/inspiratory whoop and post-tussive vomiting
- convalescent: dry cough
Dx: clinical
- NP swab PCR culture is gold standard
Mgmt:
- macrolide: erythromycin or azithromycin* [allergy = bactrim]
Bacterial pneumonia
Sxs:
- cough, fever (except w/chlamydia)
- tachypnea, malaise, emesis, dec BS, crackles
Dx:
- CXR not needed if well enough for OP tx
Mgmt:
- Typicals: Amoxicillin
- Atypicals: Azithromycin
Few weeks after birth: erythromycin for chlamydia
MC cause: viral
Asthma
Sxs:
- episodic wheezing, chronic, hyper responsive, reversible
- recurrent cough, tightness, dyspnea, atopy
Dx:
- check peak flow w/exacerbation
- Spirometry* = DEC FVC and FEV1/FEV ratio
- Methacholine challenge (induce exacerbation): hyperresponsive
Mgmt:
- SABA for all
- ICS maintenance
- ICS + LABA
- Leukotriene Modifier for atopic pt (montelukast)
- asthma action plan
- acute exacerbation: steroids
- uncontrolled: allergist referral
ABG with hypercapnia = worst prognosis
Cystic fibrosis
Et:
- lack/dysfunction of CFTR chloride channels = dehydrated, thick secretion
- A1at def
- auto recessive
Sxs:
- sinus: HA, mouth breathing, face pain, nasal polyp, purulent drainage
- lung: cough, sputum, pseudomonas
- pancreas: Inc fecal fat (steatorrhea), FTT
- GI: meconium ileus in neonates
- male: infertility and no vas deferens common
Dx: newborn screening
- Pilocarpine iontophoresis sweat test**
Mgmt:
- reduce pulmonary secretions to reduce bacterial bioburden
- nebulizers*
- chest physiotherapy*
- abx to cover pseudomonas w/exacerbations
- panc enzyme supplement
Hyaline membrane disease [neonatal respiratory distress syndrome]
Et:
- premature babies
- surfactant def** - inc surface tension in alveoli = collapse at end expiration
Sxs:
- tachypnea
- grunting
- retractions
- nose flare
Dx:
- CXR: fine granular parenchyma (glass)
- blood gas: hypoxia, then acidosis
Mgmt:
- prevent: Dexamethasone 48hr prior to premature delivery if before 34 weeks **
- adequate fluids, warm O2, CPAP
Most improve w/in 72hr
Foreign body aspiration
MC: food (nuts, hotdog)
Sxs:
- excessive drooling, inability to control secretion = obstruction
- hypoxia, cyanosis
Dx: Xray
Mgmt: refer for peds bronchoscopy
Acromegaly
PP: overgrowth of tissue (skin, bone, cartilage, CT)
Sxs:
- insulin resistance**
- lipogenesis
- enlarged jaw, swollen hands, feet, macroglossia, carpal tunnel, hyperhidrosis
Dx: endocrine
- serum IGF-1**
- MRI pituitary
Mgmt:
- transphenoidal surgery
- prolactinoma = cabergoline*
Gigantism
Children:
- same process as acromegaly but before growth plates close
Sxs: doughy hands
Dx:
- Inc GH
- Inc IGF-1
Dwarfism
Et:
- decreased GH secretion
- decreased IGF-1 production
- failure of tissues to respond to IGF-1
** eval if >3 SD below mean height for age
Dx:
- IGF1 (adult) and GH (child) levels
- ACTH, cortisol, TSH, FSH/LH
Mgmt: ped endocrine
T1DM
Sxs:
- polyuria, polydipsia, polyphagia
- weight loss, blurred vision, recurrent candida infection
- NV, abd pain
- acetone breath, sweet
- weakness, dizziness
Dx:
- GAD
- ICA512 - islet cell ab
- insulin antibody
- C-peptide (high w/low insulin)
Mgmt: insulin*
Conjunctivitis
Gonococcal: 3-5d purulent bilateral
- topical erythromycin ointment
Chlamydia: 5-14d scant mucoid d/c, chemosis, pseudomembrane formation
- PO erythromycin
Bacterial: HIB, strep, purulent discharge throughout day
- antibiotic drops or nothing
Viral: clear discharge
Allergic: cobblestone
Strabismus
Abnormal ocular alignment d/t EOM imbalance
Deviation of affected eye, asx corneal light reflex, head tilt or torticollis
Dx: POS cover/uncover
Mgmt:
- ophtho refer
- correct refractive error (glasses)
- surgical correction if needed
** MC cause of amblyopia
Acute otitis media
Sxs:
- sudden ear pain, fever, URI
- dec appetite, irritable, tugging ear, dec compliance
Dx:
- bulging TM
- mild bulging + recent onset of ear pain
- new onset otorrhea not d/t AOM
- middle ear effusion: need fluid in middle ear to diagnose
Mgmt:
- 6mo - 2y unilateral OR >2 = watchful waiting
- otherwise abx
Amoxicillin 80-90 mg/kg/d divided BID x 10d
Augmentin if abx in past 30d
PCN allergy: cefdinir, cefuroxime, clindamycin
Recurrent OM: ENT referral for tube placement
Chronic otitis media
TM retracted w/impaired mobility
No inflammation
Risk for hearing loss, cholesteatoma
Dx: PE
Mgmt:
- myringotomy tubes
- adenoidectomy
Cholesteatoma
Epidermal structure that replaces middle-ear mucosa and resorbs underlying bone
Sxs:
- recurrent/persistent otorrhea
- hearing loss
- tinnitus
D/t: ETC, recurrent AOM, or chronic OM
Mgmt: surgical removal
Dysfunction of eustachian tube
Tube fails to open during swallowing or yawning resulting in difference between air pressure
Sxs:
- aural fullness
- mild/mod hearing loss
- popping and cracking
- URI or allergies
Dx:
- retracted TM, dec mobility
- prominent bony landmarks
Mgmt:
- inhaled nasal steroids/decongestants [e.g. flonase + sudafed]
- antihistamines
- autoinflation (e.g. gum chewing)
Mastoiditis
Extension of middle ear infection through mastoid air cells
- ant/inf displacement of pinna
- erythema of pinna and mastoid
- mastoid tenderness
- otorrhea, fever
Dx: CT
Mgmt:
- admit!
- broad spec IV abx
- may need surgical debridement
Otitis externa
Inflammation of skin in external ear canal
Ear pain w/pressure to tragus or tugging
Erythema, edema, otorrhea, foul smell
Mgmt: topical steroid, antimicrobial +/- wick
- Ciprodex
- Ofloxacin
Need to make sure TM not perforated before giving steroid drop**
Tympanic membrane perforation
D/t trauma or infection
Dx: PE
- audiologic evaluation
Mgmt:
- dry ear precautions*
- trauma: resolves itself
- infection: abx oral and drops, recheck
Refer for persistent hearing loss
Acute pharyngitis
Sxs:
- fever, HA
- beefy red tonsils
- petechiae
- anterior cervical LAD
- abd pain
Dx: rapid strep w/culture reflex
Mgmt:
- PCN/amoxicillin if GAS+
- allergy: azithromycin
Epiglottis
Sxs:
- preceding URI, abrupt onset, sore throat, odynophagia, resp distress
- drooling, choking sensation, hot potato voice, sniffing position
Dx: laryngoscopy*
- Neck Xray: thumbprint sign
Mgmt:
- secure airway
- abx therapy, blood culture and epiglottic swab before
Oral candidiasis
Creamy white plaques on tongue and buccal mucosa
- usually throughout mouth, not just tongue
Scrapes off
- can bleed
peaks at 4wk
Dx: clinical
Mgmt:
- Nystatin swish 2mL TID or diflucan
GERD
Infant:
- effortless postprandial regurgitation
- irritable during feedings
- FTT
Child:
- recurrent vomiting
- chest/abd pain
Dx:
- pH monitor
- PPI therapy
- serial EGD to r/o mucosal changes
Mgmt:
- reduce acidic foods, caffiene
- weight loss, upright sleep, stress reduce
- reassurance, small frequent feeding
Treat when FTT begins:
- H2ra approved for <1yo
- Kids: omeprazole
Nissen fundoplication
- failed med therapy
- respiratory sxs
- vocal cord damage
- Barrett’s
Pyloric stenosis
Sxs:
- projectile vomiting, non-bilious
- palpable olive
Dx: U/S - pyloric wall greater than 4mm wide or 14mm long
Barium swallow: string sign
Mgmt:
- surgical consult
- ER management
Labs**
- hypochloremic
- hypokalemic
- metabolic alkalosis
Celiac disease
Systemic autoimmune disease triggered by gluten (BROW)
- villous atrophy, crypt hypertrophy, malabsorption
Sxs:
- diarrhea, bloating, abd pain, anemia, wt loss, fatigue, vitamin deficiency
- pruritic vesicular rash
Dx:
- Iga-TTG
- anti-endomysial abs
- dermatitis herpetiformis* skin bx
- gold standard: small bowel histology from bx
Mgmt: lifelong gluten free
- supplement Vit d, Ca, Fe
- eat CRAP: corn flour, rice flour, arrowroot, potatoes
Constipation
Large stool can result from colon stretching and not defecating enough
Sxs:
- firm stool, abd pain
- diarrhea, urinary sxs
- fatigue
Mgmt:
- infant: 1-2oz fruit juice, glycerin suppositories
- child: avoid pasta, fried food, and dairy – more fruit, veg, water, activity + positive reinforcement
- PEG x 6-12 mo
Fe in formula and breast milk does not cause constipation
Intussusception
- vomiting + colicky abdominal pain + currant jelly stool **
- other sxs: mass, occult blood, lethargic, septic
MC < 5yo
Cause:
- palpable purpura (a/w HSP)
- tumor
- Meckel’s diverticulum
Dx: U/S target sign
- barium/air enema
Mgmt
- barium/air contrast enema (r/o perforation)
- surgery if peritonitis present
Lactose Intolerance
Bloating, flatulence, diarrhea, cramps a/w lactose intake
Dx: Hydrogen breath test
- clinical dx
Mgmt:
- reduce/eliminate dairy
- lactaid supplement
- calcium supplement
Fecal impaction
Atypical presentation of constipation confirmed by DRE
RF: opioid, bed rest, neurogenic or spinal disorder
Sxs:
- NV, abd pain, anorexia, distension, diarrhea
Mgmt:
- digital disimpaction
- suppositories, enemas
PKU (Phenylketonuria)
Autosomal recessive
Sxs:
- intellectual disability and seizures w/out any treatment
- fair skin, light hair, musty odor, microcephaly, hyperactivity
Mgmt:
- low phenylalanine diet
What do you measure for general nutrition status?
Prealbumin
Vitamins
A: night blindness, Bitot spots
C: scurvy - ecchymosis, malaise, arthralgias
D: osteomalacia, Rickets
E: ataxia, hyporeflexia
K: bruising, GI/mucosal bleeding
Folate: anemia, neural tube defects
Thiamine (B1): Wernicke encephalopathy, Beriberi or peripheral nephropathy
Niacin (B3): pellagra - dermatitis, diarrhea, dementia
Cobalamin (B12): anemia, paresthesias, ataxia, depression
Iron def is common in ages 1-3y if not supplemented during breastfeeding
Lead poisoning
Sxs:
- HA
- motor neuropathy
- HTN
- anemia
- gout
- cognitive impairment
Dx:
- lead level > 10
- basophilic stippling*
- lead lines in wrist/knee radiographs
Mgmt:
- succimer**
- report to city
Congenital adrenal hyperplasia
Enzyme def in synthesis of cortisol and aldosterone from cholesterol
Excess 17-hydroxyprogesterone**
Dec aldo = salt-wasting
Female karyotype but indeterminant genitalia*
Dx*:
- hypoNa
- hyperK
Mgmt:
- replace cortisol +/- mineralocorticoid (fludricortisone) for life
- replace testosterone/estrogen at puberty
- refer to peds endocrine
Hypospadius
Ventral urethral meatus +/- undescended testes
Mgmt:
- surgical correction between 4-18 mo
- DO NOT Circumcise - use foreskin for surgery
Cryptorchidism
Testes have not descended through inguinal canal completely
Complications:
- infertility
- testicular CA
- trauma
- inguinal hernia
Dx:
- pelvic U/S if nonpalpable testes
Mgmt:
- 80% dec in 1st few months of life
- porphylactic orchiopexy if not cured by 6mo (prior to 2yr) to allow for proper exam for CA detection**
If you can push it into the scrotum then it was just d/t cremasteric reflex
Testicular torsion
Infant males - asx
Older male - acute scrotal pain, swelling
- testes is higher, venous congestion
Dx:
- cremasteric reflex is absent**
- US w/doppler
- raising testes Inc pain
Mgmt:
- urologic emergency
- may try manual detorsion* - rotate away from midline
Paraphimosis/Phimosis
Phimosis: inability to retract foreskin
Paraphimosis: inability to put it back
Mgmt: minimal invasion then dorsal split procedure
Wilms Tumor (Nephroblastoma)
Sxs:
- fever, anorexia, NV, abd pain, distension, hematuria, HTN
- abd mass* - incidental finding
Dx: abd U/S*
- CT to characterize
- needle bx if large and need preop rad/chemo
Mgmt:
- surgical if unilateral and resectable
- chemotherapy if advanced/bilateral
MC solid renal tumor of childhood
Salter Harris Fracture
1 (S) - same as physis
2 (A) - above physis
3 (L) - lower than physis
4 (T) - through physis
5 (ER) - eradicate the physis
Migraines
Premonitory: fatigue, dec concentration, photophobia, phonophobia, blurred vision, stiff
Aura: visual disturbance (MC)
- numbness/tingling, weakness, speech
Cutaneous allodynia
Migraine w/out aura = MC
HA 4-72hr w/2+
- unilateral, pulsating, intense, worse w/activity
- AND NV or photophobia
- normal neuro exam
Mgmt:
- triptans
- caffeine + NSAIDs
- sleep
Reversible focal neuro deficits - aura w/HA during or after
Meningitis
Et:
- preterm to <1mo: GBS, listeria, E.coli
- > 1mo to 50yr: S. pneumo, N. meningitis
Sxs: fever, HA, nuchal rigidity
- purpura fulminans: rash, DIC (nisseria)
PE:
- Kernig: hip 90deg, cannot fully extend knee
- Brudzinski: neck flexion causes hip/thigh flexion
Dx:
- LP: inc pressure, cell count, protein, and dec glucose
Mgmt:
- urgent admit for abx + dexamethasone
- neisseria/s. pneumo = Vanco + Ceftriaxone
- listeria = vanco + ceftriaxone + ampicillin
Cerebral palsy
Nonprogressive disorder of developing brain
- mc d/t hypoxic brain injury
Sxs:
- spastic diplegia
- hemiplegia
- dyskinetic
- ataxia
Dx:
- PT, speech, OT
- Baclofen - reduce muscle spasm
- Botox - spasticity
Concussion
Grade 1: no LOC, amnesia, confusion
- return to play after 15min
Grade 2: no LOC, mild amnesia, confusion >15min
- return to play if asx >1wk
Grade 3: ANY LOC, prolonged amnesia, confusion w/slow recovery
- return if asx >2wk
Never return to play once you’ve had 3 concussions
Post-Concussion Syndrome
Sxs: HA, dizziness, fatigue, irritable, anxiety, insomnia, loss of concentration/memory, noise sensitivity
Dx:
- CT only if acute worsening / changes / decompensation
Mgmt:
- reassurance most resolve w/in 3 mo
- HA: amitriptyline, propranolol
Generalized Absence Seizures
School aged children
Brief lapse of consciousness w/cessation of speech or motor activities
Can occur many times a day
Dx:
- EEG
- BMP, glucose
Mgmt: Ethosuximide*
- valproate
Generalized Tonic Clonic Seizures
Tonic: inc extensor tone
Clonic: repetitive jerking of body follows post-ictal phase
Mgmt:
- valproate
- lamotrigine
- levetiracetam
Generalized Atonic Seizures
Drop attacks - sudden loss of postural tone
Mgmt: helmet
Partial Seizures Simple
Limited motor twitching or jerking
Sensory phenomenon, autonomic NS instability
No LOC**
Mgmt:
- lamotrigine
- carbamazepine
- levetiracetam
- oxcarbazepine
Partial seizures Complex
early adolescence
simple partial seizure followed by impairement of consciousness
movements can seem purposeful but are repetitive and not situational
Mgmt: atypical
- valproate
- lamotrigine
- levetiracetam
Tourette disorder
Waxing/waning of tics for more than 1 year
Begin in childhood and last past puberty
Verbal/motor tic*
E.g. motor eye blinking, facial grimacing, head bobbing, shoulder shrug, sniffing, throat clearing
Dx: observation, history
Mgmt:
- no medication for most people
- behavioral replacement therapy
- meds: low dose clonidine, atypical antipsychotics
- Most important: treat comorbidities
ADHD
Core sxs: inattention, impulsivity, hyperactivity
- present at least 6mo, before age 12y, in 2+ settings of life
Dx: clinical
Mgmt:
- ask about Fhx of SCD prior to starting meds; ECG or echo if risk factors
Meds
- methylphenidate
- amphetamines
- cognitive strategies, behavioral intervention, education intervention
Autistic disorder
- lack of empathy, social or emotional responses
- abnormal language development
- repetitive behavior, lack of spontaneous play
Asperger’s - less severe and highly intelligent
Anorexia nervosa
Restriction of energy intake leading to low body weight, fear of gaining weight
Types
- restrictive: fasting and exercise
- binge-purge: 3 months lasting
Bulimia nervosa
Eating too much food in a short time
Feeling loss of control
Occurring once per week for 3+ mo
Obesity
BMI > 85% for age/gender = overweight
- goal: weight maintain
BMI > 95% for age/gender = obese
- goal: gradual weight loss
Sxs:
- early menstruation
- hyperlipidemia
- steatohepatitis
- DM, OSA, CAD, psych
Dx: BP, BMP, A1c, lipid panel, TSH
Mgmt:
- no more than 1 pound per month if under 11
- no more than 2 pounds per month otherwise
Child abuse
Maltreatment of child resulting in harm w/out reasonable explanation
Neglect - mc
Sxs
- bruises over soft areas, oral mucosa
- retinal hemorrhages
- glove/stocking burn
- long bone fracture before walking
Shaken baby: subdural hemorrhage, retinal hemorrhage
Buckle handle fracture: sheer off just beside physis or growth plate from twisting
Mandatory reporting = CPS
Munchausen by proxy: made ill by person they love
Oppositional defiant disorder
Lose temper Argue w/adults Angry Spiteful Vindictive Annoys others on purpose
Conduct disorder
Repetitive, persistent pattern in which basic rights of others are violated
Breaking the law/rules of an institution
Atopic dermatitis
Sxs:
- red, itchy papules and plaques, oozing and crusting
- dry papular and intensely itchy in crevices
- marked lichenification can occur
Mgmt:
- topical emmolients: Eucerin, Aquaphor
- hydrocortisone or triamcinolone
- tacrolimus, picrolimus, eucrisa
- PO antihistamines
Contact dermatitis
Sxs:
- acute onset erythema, pruritus
- limited to area of contact
- develops w/in 7-10d
- Type IV hsr
Diaper dermatitis
Irritant from urine, feces, fecal enzymes
Sxs:
- erythema on convex surface, sparing skin folds
satellite lesions = candidiasis
Mgmt:
- apply barrier cream: zinc oxide, paraffin, glycerin, lanolin
- topical antifungal therapy: nystatin, miconazole, clotrimazole, econazole
- low potency topical corticosteroids
Nummular eczematous dermatitis
- dull red, exclusive, crusted, scaly –> annular eczema
- scaly throughout (no central clearing)
Mgmt:
- high potency topical steroid
- phototherapy, systemic steroid if resistant
Perioral dermatitis
Sxs:
- small, noninflammatory papules around mouth, nose, and eyes
- narrow zone around vermillion border of lip is often spared
- often on adults who didn’t have acne as a kid
Mgmt:
- d/c topical steroids - zero therapy is best
- topical erythromycin or metronidazole +/- PO abx (doxy 100mg BID)
Immunologic drug eruption
1: classic immediate hives, anaphylaxis
2: cytotoxic - hemolysis, purpura
3: immune complex - vasculitis, serum sickness
4: starts 7-10d after tx - maculopapular itching, symmetrical on trunk/extremity
Mgmt:
- stop drug
- antihistamines
- abx ointment if eroded lesion
- epipen for anaphylaxis
Morbilliform eruption
1 viral
MC cutaneous drug reaction (Type IV)
MC cause of urticaria in peds
Fixed drug eruption
Sxs:
- dusky red, round plaques, bullae, preceded by itching/burning
Presents 30 min to 8hr after exposure at same site each time
MC Place = penis
Mgmt:
- stop drug, avoid in future
- topical steroid
- if eroded lesion - abx ointment
Lichenoid drug reaction
Mimics lichen planus
- violaceous, flat topped itchy papules
Presents 3 mo to 3 yr later
Mgmt:
- stop drug, avoid in future
- topical or systemic steroids
- intense pruritus - antihistamines
Pityriasis rosea
Prodrome: malaise, HA, constitutional sx
Rash: herald patch** - single, pink oval scaly (not itchy)
Then 5-10d - crops of ovals appear in christmas tree distribution
Mgmt:
- fades over 4-6wk
- not contagious, no treatment needed, no isolation needed
Acne vulgaris
Sxs:
- noninflammatory comodomes
- papules, pustules
- nodules, cysts
Mgmt:
- 1 benzyl peroxide wash, leave on
- 2 topical abx for a few small ones
- topical retinoid: tretinoin, adapalene
- dapsone: 35yo, no abx
- oral abx + topical retinoid
- OCPs for females
- Azeleic acid in pregnancy
Severe: PO isotretinoin for 5-6mo
Lice
Sxs:
- itchy scalp, behind ears and neck
- eggs visible on hair shaft within 1cm of scalp
- LAD and red papules possible
Mgmt:
- OTC permethrin cream, mechanical removal - repeat 1wk later to kill hatched eggs
- resistant: benzyl alcohol lotion or malathion lotion
- ivermectin (not w/pregnancy)
Scabies
Sxs
- VERY itchy lesions, papules, and burrows in abdomen, webbed spaces, axilla, genitals
Mgmt:
- permethrine cream 5%
- ivermectin single dose q week x 2
- itching can persist for weeks d/t reaction to feces = benadryl or hydroxyzine
Molluscum Contagiosum
Sxs:
- pearly smooth papules w/umbilicated center
- surrounding erythema and pruritus possible
Mgmt:
- natural, spontaneous clearnace of 2-4yr in immunocompetent individuals
- cryotherapy or salicylic acid possible
Varicella virus
Sxs:
- incubation period 14d
Prodrome: fever, malaise, fatigue, HA, throat, itchiness, vesicular rash - dew drop on a rose petal
- spread face to trunk to extremities
- macules progress to vesicles
Mgmt:
- supportive
- antivirals if immunocompromised
- varicella vax (MMR at 1yr and 4-6yr)
Impetigo
Sxs:
- superficial, contagious, infection of skin from staph or strep
- honey colored crusts**
Mgmt:
- Mupirocin* (topical abx)
- PO abx if MRSA suspected: Clindamycin OR bactrim/amoxicillin
Complication: post-strep glomerulonephritis
Candidiasis
Sxs:
- red, moist, glistening plaques with satellite lesions
- burning, itching
Mgmt:
- promote dryness
- topical antifungal - Nystatin
- low dose corticosteroid (limited time)
Tinea versicolor
Sxs:
- mild, superficial skin infection of trunk, neck, and upper extremity
- velvety tan, pink or white macules that coalesce
- fine scale if scraped
Dx:
- yellow fluorescence* under wood lamp
- KOH
Mgmt:
- topical pyrithione zinc or selenium
- topical antifungal cream
- dose or 2 of PO antifungal (diflucan)
Tinea corporis/pedis
Ring shaped lesions w/advancing scaly border and central clearing
mildly pruritic
Mgmt:
- topical terbinafine or azole cream
G6PD deficiency
Lack of ability to tolerate oxidative stress on RBC resulting in hemolysis
Sxs:
- lack of energy, chronic fatigue, pallor, jaundice*, abd pain or gallstone
- tachycardia, splenomegaly
Dx: CBC w/reticulocyte = high MCHC and retic
- peripheral smear: Heinz bodies
Mgmt:
- avoid exacerbating cause - e.g. fava beans, abx (bactrim)
Iron deficiency
D/t:
- chronic blood loss: excessive menstruation, occult blood, pregnancy, rapid growth
- lack of supplementation with strictly breastfed babies
Dx:
- screen at 12mo
- Dec ferritin, serum Fe, RBC/Hgb/Hct, transferrin saturation
- Inc TIBC, RDW
Mgmt:
- supplement at 4 months if breastfed only
- kids vitamin w/Fe
- Ferrous sulfate 325mg PO q day
Idiopathic thrombocytopenia purpura
Acute, self-limited disease after Viral illness
- previously healthy kid –> petechiae, purpura on skin and mucous membranes
Dx:
- platelet <150k otherwise normal CBC
Mgmt:
- plt count begins to rise in 1-3wk
- observe if >20k and asx
- steroids or IVIG if plt <10k and no bleeding
- plt transfusion if life threatening after
Acute lymphocytic leukemia
MC hematologic malignancy in kids
Sxs:
- fatigue, fever, lethargy, HA, infection, diffuse bone pain, petechiae, purpura, thrombocytopenia, LAD
Dx: T cell, chest mass
Mgmt:
- chemotherapy
- BMT
- high cure rate
Acute myelogenous leukemia
Clonal proliferation w/maturation arrest
Sxs:
- fatigue, petechiae, pallor
- gingival hyperplasia*
- ulcerations, thrush
Dx:
- hypercellular, blasts >20%
- CBC, LFT, BMP, LDH, DIC, bone marrow bx
Mgmt:
- chemo
- BMT
- supportive care
Botulism
Et: clostridium botulinum (gram + rod)
- canned or preserved foods w/toxin
Sxs:
- dizziness, dry mouth, blurred/double vision, abd sxs, NVDC, progressive paralysis
Infant:
- raw honey or homemade baby food
- weak sucking
- hypotonia (floppy baby)
- respiratory
Mgmt:
- horse antitoxin [+ abx for infants]
- stomach washing to remove toxin
- respiratory and cardiac support
Erythema infectiosum (5th disease)
Et: parvovirus B19
“Slapped cheek” rash
- followed by lace-like rash on trunk/extremities
- high fevers before
Mgmt: supportive
- infection control is key
Pinworms
Ingesting eggs
Itchy butt at night
Dx: tape
Mgmt: albendazole
CMV
Sxs
- congenital: blood disorder, deaf, microcephaly, fetal death
- mother: asx
Dx: IgG/IgM ab for CMV if exposed
Mgmt:
- no tx or immunization currently available
- prevention: pregnant women avoid contact w/urine or saliva of young children
EBV Mononucleosis
Prodrome:
- fatigue, malaise, anorexia, HA, fever, chills
Acute: fever, cervical LAD (posterior)
- Organomegaly, rash, grey-purple exudate on tonsils
Dx:
- mild liver elevation
- monospot - end of 1st/2nd weeks
- lymphocytosis: 50% more, 10% atypical
Mgmt:
- viral, resolves on its own
- avoid contact sports for 3 weeks d/t splenomegaly and risk of rupture
Measles (Rubeola)
Coryza, cough, Koplik spots
- erythematous, maculopapular blanching rash on face spreading down
Dx: serology
Mgmt: supportive
Mumps
Et: paramyxovirus
Bilateral swelling of parotid glands, fever, malaise, pain, trismus
Dx: serology
Mgmt:
- self-limiting
- complications* meningitis, encephalitis, hearing loss, orchitis, pancreatitis, nephritis
Roseola
Fever high, then lowers, blanching maculopapular rash on neck/trunk spreading to face and extremities
Mgmt:
- supportive
Rubella
Exanthem: pinpoint pink maculopapules
Face: trunk and extremities w/in 24hr
A/w cervical LAD*
Mgmt: supportive
Varicella
Primary: chicken pox
- vesicular lesions that become more pustular and crust by 7-10d
Secondary
- dermatomal distribution
Can see various stages of ulcers*
Dx: clinical presentation
Mgmt:
- antiviral therapy (acyclovir, valacyclovir, famciclovir)
- analgesia
