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Family Medicine > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Hypertrophic cardiomyopathy

A

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

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2
Q

Ventricular septal defect

A

** 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

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3
Q

Atrial septal defect

A

**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
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4
Q

Patent ductus arteriosus

A

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
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5
Q

Coarctation of Aorta

A

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
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6
Q

Tetralogy of Fallot

A
  • MC cyanotic congenital heart disease
  1. VSD
  2. Overriding Aorta
  3. Pulmonary Stenosis
  4. 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)

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7
Q

Acute Bronchiolitis

A

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%

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8
Q

Croup

A

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

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9
Q

Pertussis

A

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]

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10
Q

Bacterial pneumonia

A

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

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11
Q

Asthma

A

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

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12
Q

Cystic fibrosis

A

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
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13
Q

Hyaline membrane disease [neonatal respiratory distress syndrome]

A

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

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14
Q

Foreign body aspiration

A

MC: food (nuts, hotdog)

Sxs:

  • excessive drooling, inability to control secretion = obstruction
  • hypoxia, cyanosis

Dx: Xray

Mgmt: refer for peds bronchoscopy

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15
Q

Acromegaly

A

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*
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16
Q

Gigantism

A

Children:
- same process as acromegaly but before growth plates close

Sxs: doughy hands

Dx:

  • Inc GH
  • Inc IGF-1
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17
Q

Dwarfism

A

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

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18
Q

T1DM

A

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*

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19
Q

Conjunctivitis

A

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

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20
Q

Strabismus

A

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

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21
Q

Acute otitis media

A

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

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22
Q

Chronic otitis media

A

TM retracted w/impaired mobility
No inflammation
Risk for hearing loss, cholesteatoma

Dx: PE

Mgmt:

  • myringotomy tubes
  • adenoidectomy
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23
Q

Cholesteatoma

A

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

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24
Q

Dysfunction of eustachian tube

A

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)
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25
Q

Mastoiditis

A

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
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26
Q

Otitis externa

A

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**

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27
Q

Tympanic membrane perforation

A

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

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28
Q

Acute pharyngitis

A

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
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29
Q

Epiglottis

A

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
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30
Q

Oral candidiasis

A

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

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31
Q

GERD

A

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
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32
Q

Pyloric stenosis

A

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
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33
Q

Celiac disease

A

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
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34
Q

Constipation

A

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

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35
Q

Intussusception

A
    • 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
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36
Q

Lactose Intolerance

A

Bloating, flatulence, diarrhea, cramps a/w lactose intake

Dx: Hydrogen breath test
- clinical dx

Mgmt:

  • reduce/eliminate dairy
  • lactaid supplement
  • calcium supplement
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37
Q

Fecal impaction

A

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
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38
Q

PKU (Phenylketonuria)

A

Autosomal recessive

Sxs:

  • intellectual disability and seizures w/out any treatment
  • fair skin, light hair, musty odor, microcephaly, hyperactivity

Mgmt:
- low phenylalanine diet

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39
Q

What do you measure for general nutrition status?

A

Prealbumin

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40
Q

Vitamins

A

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

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41
Q

Lead poisoning

A

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
42
Q

Congenital adrenal hyperplasia

A

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
43
Q

Hypospadius

A

Ventral urethral meatus +/- undescended testes

Mgmt:

  • surgical correction between 4-18 mo
  • DO NOT Circumcise - use foreskin for surgery
44
Q

Cryptorchidism

A

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

45
Q

Testicular torsion

A

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
46
Q

Paraphimosis/Phimosis

A

Phimosis: inability to retract foreskin

Paraphimosis: inability to put it back

Mgmt: minimal invasion then dorsal split procedure

47
Q

Wilms Tumor (Nephroblastoma)

A

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

48
Q

Salter Harris Fracture

A

1 (S) - same as physis

2 (A) - above physis

3 (L) - lower than physis

4 (T) - through physis

5 (ER) - eradicate the physis

49
Q

Migraines

A

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

50
Q

Meningitis

A

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
51
Q

Cerebral palsy

A

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
52
Q

Concussion

A

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

53
Q

Post-Concussion Syndrome

A

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
54
Q

Generalized Absence Seizures

A

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

55
Q

Generalized Tonic Clonic Seizures

A

Tonic: inc extensor tone
Clonic: repetitive jerking of body follows post-ictal phase

Mgmt:

  • valproate
  • lamotrigine
  • levetiracetam
56
Q

Generalized Atonic Seizures

A

Drop attacks - sudden loss of postural tone

Mgmt: helmet

57
Q

Partial Seizures Simple

A

Limited motor twitching or jerking

Sensory phenomenon, autonomic NS instability

No LOC**

Mgmt:

  • lamotrigine
  • carbamazepine
  • levetiracetam
  • oxcarbazepine
58
Q

Partial seizures Complex

A

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
59
Q

Tourette disorder

A

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
60
Q

ADHD

A

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
61
Q

Autistic disorder

A
  • lack of empathy, social or emotional responses
  • abnormal language development
  • repetitive behavior, lack of spontaneous play

Asperger’s - less severe and highly intelligent

62
Q

Anorexia nervosa

A

Restriction of energy intake leading to low body weight, fear of gaining weight

Types

  • restrictive: fasting and exercise
  • binge-purge: 3 months lasting
63
Q

Bulimia nervosa

A

Eating too much food in a short time

Feeling loss of control

Occurring once per week for 3+ mo

64
Q

Obesity

A

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
65
Q

Child abuse

A

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

66
Q

Oppositional defiant disorder

A 
Lose temper
Argue w/adults
Angry
Spiteful
Vindictive
Annoys others on purpose
67
Q

Conduct disorder

A

Repetitive, persistent pattern in which basic rights of others are violated

Breaking the law/rules of an institution

68
Q

Atopic dermatitis

A

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
69
Q

Contact dermatitis

A

Sxs:

  • acute onset erythema, pruritus
  • limited to area of contact
  • develops w/in 7-10d
  • Type IV hsr
70
Q

Diaper dermatitis

A

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
71
Q

Nummular eczematous dermatitis

A
  • dull red, exclusive, crusted, scaly –> annular eczema
  • scaly throughout (no central clearing)

Mgmt:

  • high potency topical steroid
  • phototherapy, systemic steroid if resistant
72
Q

Perioral dermatitis

A

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)
73
Q

Immunologic drug eruption

A

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
74
Q

Morbilliform eruption

A

1 viral

MC cutaneous drug reaction (Type IV)

MC cause of urticaria in peds

75
Q

Fixed drug eruption

A

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
76
Q

Lichenoid drug reaction

A

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
77
Q

Pityriasis rosea

A

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
78
Q

Acne vulgaris

A

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

79
Q

Lice

A

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)
80
Q

Scabies

A

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
81
Q

Molluscum Contagiosum

A

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
82
Q

Varicella virus

A

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)
83
Q

Impetigo

A

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

84
Q

Candidiasis

A

Sxs:

  • red, moist, glistening plaques with satellite lesions
  • burning, itching

Mgmt:

  • promote dryness
  • topical antifungal - Nystatin
  • low dose corticosteroid (limited time)
85
Q

Tinea versicolor

A

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)
86
Q

Tinea corporis/pedis

A

Ring shaped lesions w/advancing scaly border and central clearing

mildly pruritic

Mgmt:
- topical terbinafine or azole cream

87
Q

G6PD deficiency

A

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)

88
Q

Iron deficiency

A

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
89
Q

Idiopathic thrombocytopenia purpura

A

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
90
Q

Acute lymphocytic leukemia

A

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
91
Q

Acute myelogenous leukemia

A

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
92
Q

Botulism

A

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
93
Q

Erythema infectiosum (5th disease)

A

Et: parvovirus B19

“Slapped cheek” rash

  • followed by lace-like rash on trunk/extremities
  • high fevers before

Mgmt: supportive
- infection control is key

94
Q

Pinworms

A

Ingesting eggs

Itchy butt at night

Dx: tape

Mgmt: albendazole

95
Q

CMV

A

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
96
Q

EBV Mononucleosis

A

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
97
Q

Measles (Rubeola)

A

Coryza, cough, Koplik spots
- erythematous, maculopapular blanching rash on face spreading down

Dx: serology

Mgmt: supportive

98
Q

Mumps

A

Et: paramyxovirus

Bilateral swelling of parotid glands, fever, malaise, pain, trismus

Dx: serology

Mgmt:

  • self-limiting
  • complications* meningitis, encephalitis, hearing loss, orchitis, pancreatitis, nephritis
99
Q

Roseola

A

Fever high, then lowers, blanching maculopapular rash on neck/trunk spreading to face and extremities

Mgmt:
- supportive

100
Q

Rubella

A

Exanthem: pinpoint pink maculopapules

Face: trunk and extremities w/in 24hr

A/w cervical LAD*

Mgmt: supportive

101
Q

Varicella

A

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

Family Medicine (17 decks)

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