Pediatrics 2 Flashcards
GI, GU, Cardio, ENT, Resp, and DERM
1
Q
White plaques inside mouth on mucosal surface that is a common oropharyngeal infx
Tx
A
Thrush
Oral Topical Nsytatin and antifungal fluconazole PO
Tx - of mother’s nipples and bottle nipples boiled 20min Inhaler steroids–> cause
2
Q
pain, breathing difficulties, poor growth from poor feeding, iron deficiency anemia,
retrograde movement of gastric contents upwards. increased risk of asthma, esophageal stricture, barretts
A
Gastro Esophageal Reflex Disease
3
Q
Dx and of GERD
A
24 hour esophageal pH probe “Gold standard”
Upper GI barium fluoroscopy (R/O Anatomy causes)
Upper endoscopy EGD (Evaluate known GERD)
4
Q
Tx GERD
A
Thicken formula w tsp of rice cereal
smaller more frequent feedings
Upright position
casein formula- no eating prior to bed
Ranitidine, Metoclopromide, sx,
5
Q
Retrosternal and epigastric pain. caused by GERD, medication, caustic chemicals, candida.
dx endoscopy-
A
Esophagitis
6
Q
Tx Esophagitis
A
NPO and Iv fluids
Viscous lidocaine PPIs
Sucralfate Metoclopramide
7
Q
FTT, vomiting, vague abd. pain, dysphagia, food impaction. DX - w biopsy= eosinophils > 15
Barium swallow- stricture or food impaction. Patch testing.
A
Eosinophilic Esophagitis
Tx- High dose PPI
8
Q
Daily pain. Not assoc. w meals or relieved by defecation. Assoc. w anxiety, school stress,
worse in am. prevents from attending school. No evidence to explain s/s. 1/week for 2 mos.
A
Functional Abdominal Pain
9
Q
Fluctuating stool pattern between constipation and diarrhea. Defecation relieves pain. School avoid 2ndary
Assoc w change in frequency and form of stool. 1/wk for 2 mos
A
Irritable Bowel Syndrome
10
Q
Frequently watery stools with normal growth/weight gain. DT excessive intake of sweetened liquids
caloric intake is adequate. S/S lasts >4 weeks
A
Functional Diarrhea
Tx- Fiber, probiotics, CBT SSRI, dec. milk intake
11
Q
<= 2 stools/week or passage of hard pellet like for at least 2 wks. Retentive posturing.
A
Constipation
Tx- Polyethylene Glycol Milk of magnesia, Mineral oil (Non-habit)
12
Q
Regular voluntary or involuntary passage of feces into a place other than the toilet >4 YOA
Chronic constipation #1 cause. Assess for rectal fissures. KUB to confirm fecal size
A
Encopresis
TX- Encourage regular stooling. Inc fluid/fiber. Child must be pain free 1st then goal is to relief constipation
13
Q
injury to small intestine mucosa from gluten. Wheat, Rye, barley, –> malabsorption and malnutrition
Assoc w DM1, Thyroiditis, **Turner syndrome and Trisomy 21 **
A
Celiac Disease
14
Q
Dx of celiac Dz
A
Must be eating Gluten when testing. Serum IgA Antigliadin Ab Villous Atrophy- mucosal inflammation
Tx- Life long avoidance Gluten
15
Q
Milk or soy protein induced colitis. Common cause of bloody stools in infants. less common in breast fed.
Abd. distention, gas, fussiness after feeds. loose, blood streak tools. No NVD or abd. pain
Dx- Eosinophils in feces and rectal mucosa biopsy
A
Allergic colitis
Tx - Casein hydrolysate Mom restricts Milk and soy
16
Q
MC cause diarrhea in winter. vomiting 2-4 days, diarrhea 7-10 days. dehydration in children. vaccination–> less common
Associated ocean cruises.
A
Rotavirus
Norovirus (Calcivirus)
17
Q
Fever, HA, Abd. pain, worsens over 48-72 hrs w nausea, decreased appetite or constipation.
Bowel perforation in adults, hematochezia or melena
chronic carriers are asymptomatic
A
Typhoid fever (Salmonella Typhi)
18
Q
Transmitted via contact w infected animals. chieckens, iguanas, reptiles, turtles. Dairy, eggs and poultry
A
Nontyphoidal salmonella
19
Q
Bloody diarrhea w high fever. blood and mucus foul smelling. Shiga toxin-Shigella
blood loss significant w EHEC, EIEC, Campylobacter, Yersinia
A
Dysentery
20
Q
Watery non bloody or mucoid. Absent or low grade fever. Involves ileum. 4-5 stools a day last 4 days
A
V. Cholerae or ETEC Entero toxin E Coli
21
Q
person-person contact and contaminated water/food
Poultry, raw milk, cheese. self limited.
Abx if high fever or grossly blood diarrhea, s/s over 1 week or immunocomp
A
Campylobacter Jejuni
22
Q
Transmitted by pets and contaminated food especially chitterling (tripitas) mimics appendicitis or Crohn’s
Post infectious arthritis, rash, spondylopathy.
tx supportive care
A
Yersinia Enterolitica
23
Q
Pseudomembranous colitis in hospitalized inpatient. Assoc. w abx use –> overgrowth of bacteria–> infl. bowel
Tx - DC ABx, Metronidazole or vancomycin
A
Clostridium Difficile
24
Q
Endemic to US, day care centers. freshwater/well contaminated, infected feces–> ingested cyst
progressive anorexia, nausea, gaseousness, abd. distention.
A
E. Hystolitica/Giardia Lamblia
Cryptosporidium Parvum (Prolonged diarrhea Aids)
25
Tx for Acute Gastroenteritis
Shigella- Cipro
Salmonella- Cipro (Ampicillin immune comp)
E. Coli- Cipro-Z pack (Not 0157)
C. Difficile and Giardia (Metronidazole)
26
Fluid resuscitation for kids and neonates
20ml/kg
10ml/kg Neonates (Give over 20 min, Both)
Both X3 boluses max then admit
27
Maintenance fluid therapy (D5W if maintenance)
4ml/kg/hr for 1st 10kg
2ml/kg/hr for second 10kg
1ml/kg/hr for each kg> 20kg
1/2 over 8 hrs remainder over 16 hrs
28
autoimmune destruction of pancreatic islet cells (Beta cells) permanent insulin deficiency.
Polydipsia
polyuria
polyphagia
Diabetes Mellitus I
29
Dx of DMI or DM II
Requires two separate tests
Fasting glucose= >= 126 mg/dL
Random venous Plasma >= 200 mg/dL
Oral Glucose tolerance test >=200mg/dL 2 hr post 75G
HgB A1C >=6.5
30
Acute MC complications of Diabetes Mellitus, Tx
Hypoglycemia
glucagon or IV Glucose
31
Physiologic GH release -->early am hyperglycemia that persists throughout night.
Tx increase PM insulin dose
Dawn Phenomenon (Common)
32
Toolarge night time insulin dose leads to early am hypoglycemia-->rebound hyperglycemia on waking
Tx- Decrease PM insulin
Somogyi Phenomenon
33
Occurs when DM1 not detected/dx/poor compliance.
Metabolic acidosis w anion gap. severe dehydration
decreased tissue perfusion. incr. lactic acid prod. Kussmauls rep., NV, polyuria/dipsia, K+ depleted
fruity odor on breath. AMS
Diabetic Ketoacidosis
34
Dx and Tx
Serum Glucose 200-1,000, pH 7.3, Bicarb < 15
Tx- Fluids 1st, Insulin Iv- 0.1 U/kg/hr
35
Most serious complication of Diabetic Ketoacidosis
Cerebral Edema
Tx IV mannitol, ET/ventilate, subdural bolt
36
Peripheral resistance and compensatory hyperinsulinemia. pancreatic failure. obesity Afr. Amer.
Acanthosis Nigricans. Metabolic syndrome
DM II
Tx- Metformin 1st line
37
Group of dominantly inherited forms of mild diabetes
No insulin resistance.
Insufficient insulin secretory response to Glycemic stimulation. Tx sulfonylureas
Maturity-Onset Diabetes of youth (MODY)
38
Neonatal Renal disease Dx
UA/ Urine Cx (always w peds UA)
Ultrasound 1st Line
Voiding Cystourethrogram (VCUG)
39
Dx Modality for kidney structure and function
CT and MRI
40
Dx Modality observes reflux and evaluates urethra
| repeated filling/emptying of bladder after radio dye
Voiding Cystourethrogram (VCUG)
41
Dx modality that evaluates kidney size, scars, and fx /excretion
Readionuclide studies
42
Neonate- Failure to thrive, feeding, problems feeding, fever.
1mo-2 yrs: Feeding problems, FTT, diarrhea, vomiting, unexplained fever. (All unexplained fevers)**
> 2 yrs: urgency, dysuria, frequency, abd./back pain
Urinary tract infection
43
UTI Dx
Pyuria> 50,000 older >100,000
Urine Luekocyte esterase and nitrate (70% sensiyive)
>3-5 Epithelial cells = worry for validity of UA(Transurethral catheterization)
44
UTI Tx:
Positive Urine Cx and No ill appearing= PO Abx
| Toxic dehydrated, no PO, 14 days parenteral Abx
No response w/I 2 days re-eval and prompt imaging
45
Investigation of UTI through imaging
Renal/Bladder US- All boys w UTI, girls <3 yoa,
3-7 yoa Girl >101.3
Abnormal US--> VCUG
46
retrograde urine flow from bladder up to the ureter or kidney. caused by congenital ureterovesical Jx incomp.
Cystitis or bladder obstruction--> intravesicular pressure.
Vesicoureteral Reflux (VUR)
47
Reflux into ureter, ,pelvis, and calyx w mild to moderate dilation or tortuosity of ureter pelvis
Grade III VUR
48
Moderate dilation /tortuosity of ureter /pelvis. complete obliteration of sharp angle of fornices
maintenance of papillary impression within calyx.
Grade IV VUR
Tx- Prophylactic Abx therapy
Dextranomer/hyaluronic acid copolymer
Sx
49
Gross dilation /tortuosity of ureter /pelvis w loss of papillary impressions in most calyces
Grade V VUR
Tx- Prophylactic Abx therapy
Dextranomer/hyaluronic acid copolymer
Sx
50
Reflux into ureter but does not extend to renal pelvis.
Reflux into ureter, pelvis, renal calyx but no dilation.
Grade I VUR
Grade II VUR (Both resolve w/o sx)
Tx- Dextranomer/hyaluronic acid copolymer
51
Persistent heavy proteinuria (Albuminuria). Hypoproteinemia, hypercholesterolemia, Edema
Reduced plasma oncotic pressure, GFR and renal flow remain normal. HLA types higher incidence.
MC pitting edema or ascites, HTN 25%, sudden dec. in Albumin, proteinuria x2 random urine,
Nephrotic Syndromes
52
Primary Nephrotic syndromes
Focal Glomerulosclerosis
Minimal Change
Membranoproliferative
Idiopathic membranous nephropathy
53
Absence of gross Hematuria*, MC form of its class. Responds well to steroids. (No renal Bx)
Renal insufficiency, HTN, hypocomplementemia
(Normal C3 Complement)
Minimal Change Nephrotic Syndrome
54
Less impressive proteinuria circulating factor affecting glomerular permeability found in some patients
Initially respond to steroids, but later build resistance
Primary Focal/Focal Segmental Glomerulosclerosis
55
Hypocomplementemia w signs of glomerular dz
High likelihood of kidney failure over time
Membranoproliferative Glomerulonephritis
56
MC in adolescents and children w systemic infections
| HEP-B, Syphilis, malaria, toxoplasmosis, Gold Penicillamine
Idiopathic Membranous NS
57
Secondary nephrotic syndromes
SLE, Henoch-schonlein purpura, Wegener (Vasculitis)
Chronic infections (Hep-B/C, Malaria, HIV
Allergic reactions DM CHF Thrombosis
58
Nephrotic Syndrome Dx
Renal biopsy when Minimal Change NS not suspected
24 hr urine protein Low serum protein Albumin
59
Gross hematuria, proteinuria, edema, Oliguria, renal insufficiency
Glomerulonephritis
60
Glomerulonephritis types
Rapidly progressive Glomerulonephritis
Post-streptococcal Glomerulonephritis
Hereditary Nephritis (Alport Syndrome)
IgA Nephropathy (Berger's)
61
X chromosome mutations in type IV collage--> abnormal glomerular basement membrane
Males: Renal failure and SNHL (Hearing)
Females: Microscopic hematuria (More benign course)
Hereditary Nephritis (Alport Syndrome)
62
MC chronic Glomerulonephritis. Microscopic/ recurrent Hematuria concurrent w URI. Inc risk for ESRD
Normal compliment levels. Renal Bx definitive
IgA Nephropathy (Berger's Dz)
63
MC Acute Glomerulonephritis. Boys 2-12 yoa after pharyngitis (5-21 days post) Impetigo (4-6 wks post)
Abx still warranted , does not prevent. 95% recover completely. Antistreptolysin blood test
Post-Streptococcal Glomerulonephritis
64
Renal insufficiency progresses quickly and severely. Glomerular epithelial proliferation w crescents.
Early recognition crucial to prevent ESRD
rapidly Progressive Glomerulonephritis
65
Glomerulovascular injury caused by a toxic infection microangiopathic hemolytic anemia/Thrombocytopenia
Renal injury. Prodromal diarrhea illness. MC E. Coli 0157:H7 and shigella toxin. Schistocytes Micro slide
enterocolitis w bloody stool. HTN, Inc. Amylase/lipase
Hemolytic Uremic Syndrome (HUS)
66
Hemolytic Uremic Syndrome (HUS) Tx
IV repletion HTN Control (95% recover)
Renal insufficiency--> Dialysis
Transfusions Abx/Andiarrheals--> HUS
67
Gene mutations resulting in cystic dysfx kidneys. MC inherited kidney dz. Polycystin 1 or 2 defects.
Hepatic, pancreatic, splenic, ovarian cysts. Middle adulthood
Polycystic Kidney Dz Autosomal Dominant
68
Gene mutations resulting in cystic dysfx kidneys. Fibrocystin defects. Marked Bilateral enlargement.
Kidney failure early adulthood. Hepatic fibrosis. flank masses, interstitial fibrosis and tubular atrophy
Polycystic Kidney Dz Autosomal Recessive
69
Produces no symptoms because collecting system develops normally and ureters enter the bladder
7% have Turner's syndrome
Horeshoe Kidney
70
Unilateral normal to reduced renal fx. assoc. w VUR, VACTERL, Turner's. BILAT insuff. lung develop.
Assoc. w potter's syndrome. Flat facies, Clubfoot, pulmonary hypoplasia. Common DM Af Amer
Bilat multicystic/ Dysplastic kidneys
Renal Agenesis
71
Sudden onset intense unilateral testicular pain. triggered by sudden movement/sports. adolescents
NV, bell clapper deformity. High riding testicle, absent cremasteric reflex (stroke and elevate teste), negative phren's (inc. pain w lift)
Testicular torsion
72
Testicular torsion Dx & Tx
Dx- US Doppler absent blood flow
Immediate Urology consult: Detorsion w/I 6 hrs
73
MC in premature infants. Can lead to testicular cancer 5X and infertility. If not accomplished by age 1 yoa refer
Cryptorchidism (Orchyplexy 2 yoa)
74
Fluid collection in tunic vaginalis. Common in neonates
Communicating= w peritoneal space. Translluminates
small in am enlarges during the day (sx persists)
Non-communicating processus vaginalis obliterated (Resolve spontaneously) if persist 1 yoa refer
Hydrocele
75
Failure of the ventral urethral folds to fuse--> proximal and ventral urethral meatus on penile shaft
Assoc. w undescended testes 10%, sx correction prior to 18 mos old
Hypospadias (No circumcision)
76
Decreases UTI risk in 1st year of life. Decreased phimosis/paraphimosis and dec. cancer risk
Circumcision
77
primary- FMHX w no ID cause
Secondary- UTI, DM, D. Insipidus, Chronic COnstipation
Tx - Constipation cure, alarm (70% effective), Desmopressin, imipramine
Enuresis
78
Definitive and TOC for cardiac abnormalities.
Echocardiography
79
Functional benign murmurs
Still's Murmur
Venous Hum
Pulmonic flow murmur
80
Pathologic Murmurs
Systolic-AS PS, MR, MVP, TR, ASD, Syst
Sys/Dia- PDA (Throughout)
Diastolic- PR, AR, PS, TS S3, S4, VSD
81
MC congenital heart defect. <3mm= Asymptomatic
>5mm=CHF and FTT "Harsh Pan-systolic" @ LLSB, Pulmonary HTN
3-5 mm= Moderate s/s: CXR- Biventricular enlargement
EKG-LVH, Tx-Mod-Large= Diuretics dec. afterload 1/3 close spontaneously. Tx-Sx
Ventricular septal Defect
82
MC symptomatic pediatric dysrhythmia
supra Ventricular Tachycardia
83
>= 3 consecutive PVCs
Ventricular Tachycardia
84
Prolonged PR interval that is asymptomatic
| Tx-
1st degree Heart Block
85
Progressive PR Interval prolongation until QRS dropped Going going gone
PR interval Unchanged QRS dropped
Tx
2nd Degree Type I (No Eval/Tx)
2nd Degree type II (Pacemaker)
86
No relationship between atrial and ventricular activity
3rd degree HB (Intervene)
87
Opening between right and left atrium allowing for a R-L shunt prostaglandin E maintains open
Foramen Ovale
88
Opening between the pulmonary artery and aorta allowing for a R-L shunt
Ductus areteriosus
89
Rarely symptomatic, Fixed split @ LUSB "Rumbling Murmur" 2DT inc. blood flow across Tricuspid.
CXR- Cardiomegaly, R Atrial Enlarged, Prominent pulmonary Artery. EKG- R axis deviation N RVH
Atrial Septal Defect (Present @ age 3= Sx closure)
90
2nd MC defect. Small =Asymptomatic Large=CHF
Bounding pulses w widening Pulse Pressures.
Continuous "Machine like murmur" @ LUSB--> L Back
CXR-Full Pulm. silhouette EKG LVH/RVH TX-
Patent Ductus Arteriosus (Indomethacin)
91
Exertional Dyspnea and fatigability Rough Systolic w ejection click LUSB Radiates to back /RUSBRadiates to neck.
Tx Valvuplasty -- Sx if fails
Aortic Stenosis (Aortic Dilation)
Pulmonary stenosis (Pulmonary Artery dilation)
92
Femoral Pulses weaker and more delayed than R Radial pulse. BP in legs > than Arms
Systolic murmur @ LUSB w radiation to L Upper back
HTN in UE. CXR- Ribnotching, Aorta bulge. Turner's AS
Coarctation of the aorta
93
Cyanotic Lesions 5 Ts
Tetralogy of Fallot
Transportation of the great vessels
Tricuspid Atresia
Truncus Arteriosus
Total Anomalous Venous Return
94
MC cyanotic Heart Defect. Progressive cyanosis by age 4 mos. Hypoxic tet spells Squatting relieves spells
Rough sys. murmur LUSB (PS) CXR-Boot shape heart.
PGE indicated if cyanotic at birth. Sx repair
Spontaneous worsening cyanosis,Restless, agitation
Tetralogy of Fallot
95
Tetralogy of Fallot 4 cardinals
- Overriding Aorta
- Pulmonary Stenosis
- VSD
- RVH
96
2nd MC cyanotic lesion. Aorta arises from RV deoxy. Pulm. artery arises from LV- Oxygen blood to lungs.
No periphery flow unless L-R shunt present. ASD, VSD, PDA. Failure to pink up @ birth CXR-Egg on a string
Tx-PGE Patent PDA poor prognosis
Transposition of the Great vessels
97
Failure of the tricuspid area to form --> hypoplastic RV
Blood flow to RA must cross ASD to LA. VSD must be present
If no VSD present PDA must be kept patent w PGE-Sx
Tricuspid Atresia
98
Failure of septation of truncus- single arterial trunk that contains Aorta and Pulmonary artery. VSD present
Tx sx repair
Truncus Arteriosus
99
Pulmonary veins fail to connect to LA. If ASD not present= not life compatible. Tx- Sx repair
Total Anomalous Venous return
100
Developmental failure of aortic arch, Aortic valve, or mitral valve. Poor LV dev.--> poor systemic circulation
RL Ductus Arteriosus dependent. MC Cardiac defect deaths in 1st month of life. Multiple sx
Hypoplastic Left Heart syndrome
101
Tricuspid valve leaflet malformed/ partly attached to Tricuspid valve (TR)--> leaky valve. Small RV- Large RA
TR blood leaked backwards RV to RA--> R-L shunt through Foramen Ovale--> PFO-- Cyanosis
CXR-Box shaped heart EKG RBBB
Ebstein's Anomaly
102
Streptococcal Abs cross-react w cardiac Ag. --> scar
MC 6-15 yo infx 2-6 wks prior to rheumatic fever
Lab: Antistreptolysin O titer: Dx Base on Jones criteria 2 Maj or 1 Major 2 minor Tx- Abx Bicillin/Erythromycin
cortico-Steroids w severe carditis
Rheumatic Fever
| Long term Tx- Bicillin q 28 days lifetime w valve defects
103
Viral MC etiology. Bacterial Staph n Strep. 2DT RF, RA, SLE. Pulses Paradoxus >10mmHg w insp.
Narrow pulse pressures, distended Neck veins, Friction rub Ausc., pain Inc w lying down or sitting distant HS
Pericarditis
104
Dx-Tx Pericarditis
Globular cardiac silhouette (Water Bottle sign)
EKG- Reduced QRS voltage N Electrical Alternans
(Pericardiocentesis NSAIDS)
105
High RF prosthetic valves. cyanotic CHD, valvular lesions. Dental oral procedures, central vasc. catheter
Tachycardia N new changed murmur. Dental Sx procedures or CHD--> blood culture. splinter hemorhhrages, osler node, jane way lesions.
```
Infective Endocarditis
(Prophylaxis all dental procedures Amox)
```
106
Primary HTN MC ?
Secondary HTN MC Cause
Tx
Primary- MC Obese MC cause in adolescents
Secondary- Renal Dz (More severe Elevated)
CCBs or ACEi
107
Fixation and visual tracking occurs at what age?
Eye alignment should be complete by?
Visual Acuity and fundal exam by what age?
6 wks old
4mos
3 YOA
108
unilateral or bilateral central vision loss due to inappropriate visual development.
Amblyopia
109
neonatal conjunctivitis:
Day 1-3?
Day 2-7 ?
Day 3-21 ?
1-3 Chemical
2-7 Staph, strep, Pseudomonas, E.coli
3-21 HSV
110
Neonatal conjunctivitis
Chlamydia?
Gonorrhea
S. Aureus
Pseudomonas
Chlamydia- Erythromycin 14 days
Gonorrhea- Ceftriaxone single dose 25-50mg/kg
S. Aureus - erythromycin
Pseudomonas- Fluoroquinolones
111
Pre-auricular node, watery scant mucoid DC, mainly adenovirus 8-19. Follicular* response, Moderate -severe
Conjunctivitis Viral
112
Pruritus,watery DC, eyelid edema w cobble stoning, Blebs, Tx AH1, NSAID
Allergic conjunctivitis
113
Eyelid margin inflammation DT S. Aureus. Seborrhea or Meibomian gland dysfunction. Tx baby shampoo
Erythromycin, warm compresses
Blepharitis
114
Tear duct blockage. complete obstruction. May progress to orbital cellulitis.
Tx- warm compresses and topical Abx
Dacryocystitis- Acute
Dacryostenosis- Chronic (Partial Blockage)
115
Infected gland of zeis at base of eyelash follicle. Tender and erythematous. Tx warm compress 4-6x/day
No resolution in 2 weeks = refer Ophtho
Hordeolum (Stye)
116
Meibomian gland obstruction granulomatous gland inflammation. wks-mos. Tx ophtho steroid inj.
Chalazion
117
Serious complication of sinusitis. Bacterial spread into orbit through wall. True ER. Hospital IV ABX, CT
Cefazolin or Clindamycin/ Cefuroxime + metronidazole
MRSA Vancomycin + Cefotaxime + Clindamycin
Orbital Cellulitis
118
MC S. Pneumoniae, H. Influenzae, M. Catarrhalis
Rhinovirus, influenza, RSV. Middle ear effusion/Inflamm.
Bulging TM, Decreased absent TM mobility. TM fluid level. Otorrhea otalgia. Amoxicillin 80-90mg/kg, Ceftriaxone 50mg/kg, cefdinir 2ndary.
Acute Otitis Media
119
if recurrent less than 1 month of tx
if recurrent more than 1 month of tx
when to refer to ENT
change Abx
Same Abx
>3 episodes in 6 mos or >4 episodes in 12 mos
Persistent effusion > 3mos
120
Posterior auricular tenderness/swelling/erythema + otitis media signs. pinna displaced down/outward
Systemic abx and ENT. Drainage if abscess formation
Mastoiditis
121
External auditory canal inflamed and exudation. MC Pseudomonas Aeruginosa. Ear pain, DC, pinna tender
Tragus tender, tender chewing, erythema n Edema.
Ofloxacin or Ciprofloxacin w hydrocortisone. Polymixin
Otitis Externa (Swimmer's Ear)
122
Common Cold MC Virus
Rhinovirus, Corona, RSV
Otitis Media MC complication.
123
MC pathogen Step Pneumoniae. Physical findings lasting 10-14 days w/o improvement or inc. severity.
Mucopurulent rhinorrhea, nasal stuffiness, cough. nasal quality voice, halitosis, facial swelling. HA (CT)
Sinusitis (Tx AugmentinX14 days)
124
Atopic triad
Eczema, asthma, allergic rhinitis
125
thin rhinorrhea, nasal congestion, eye pruritic, cobblestoning, allergic shiners, transverse nasal crease.
Nasal turbinate bogginess/pallor/clear watery secretions
Allergic rhinitis (Nasonex Flonase)
126
MC viral pathogens- Rhinovirus, corona, adeno.
Bacterial GABH Strep, Spyogenes. Uncommon 2-3 yo
Palate petechiae, Fever, sore throat, Tonsilar enlargement, exudate, Ant. LAD, centor criteria
Fever, Ant. LAD, Cough Absent, Exudates, 3-14 yoa
Pharyngitis/Tonsilitis (Bicillin Pen V or Azithromycin)
127
harsh sound caused by partially obstructed airway. Commonly heard during inspiration
Stridor (MC Laryngomalacia Floppy larynx)
128
partial obstruction of the lower airways. MC heard during expiration. Low pitch- Central High- peripheral
Wheezing
129
Irregular course rattling due to secretions in intrathoracic airways.
Rhonchi
130
Fluid secretions in small airways produces sound like crumpling cellophane
Rales
131
Narrowest portion of the airway < 3 yoa
Narrowest portion of airway older children adults?
Cricoid ring
Glottis
132
Viral URI caused by Parainfluenza/RSV. Fall early winter. MC MRI Barking seal harsh cough. labor breathing
CXR- Steeple sign- subglottic narrowing. Tx- Dex 0.6-1.0 mg/kg Im or PO(Mild) Neubilizer Racemic Epi
Croup
133
Risk of sudden airway obstruction. Group A Strep, S Aureus H influenza B, direct observation of cherry red
Swollen supraglottic. CXR-Thumb sign, substernal retractions, tripod position, nasal flaring, Drooling.
Muffled hot potato voice.
Epiglottitis (Tx-Abx ET tube)
134
MC chronic Dz of childhood. B>G, smooth muscle contraction, pulm. inflammation, inc. mucous secretion.
Early-airway bronchospasm, late-airway inflammation. Relief of s/s w albuterol. Dx- spirometry PFT. Obstructive pattern post stimulus w B agonist relief
Asthma (<5 yo trial of Rx=Dx)
135
Peak Flow meter for asthma.
Every symptomatic patient and annually in office X 3 readings.
PEF<50%= Immediate Tx (Red Zone)
PEF 50-79%= Inc. Dose or Add Rx
80-100%= asymptomatic continue regimen
136
Inhaler that causes anxiousness, tremor, racing heart, transient mild hypokalemia. W spacer
Albuterol
137
Adjunct if minimal improvement after albuterol
Ipatropium
138
Greatest benefit shorten duration for acute exacerbation "burst therapy" reduces urgent care/ER
Prednisone 1-2 mg/kg Oral Parenteral
139
1st line medication for persistent asthma. Reduces comorbidity, airway hyperreactivity, rescue inhaler therapy, hospitalization, death. --> thrush hoarse voice
Inhaled Corticosteroids
140
Modest efficacy alone or in combo w inhaled steroid. Effective in exercise induced asthma
Montelukast (Leukotriene Rec.)
141
Long acting muscle relaxant 12 hrs. Used in combo w inhaled steroid for chronic asthma management.
LABA Long Acting Beta Agonist
142
Infx of pharynx/Larynx. X3 stages Catarrhal stage-nasal secretion and low fever.
Paroxysmal 2- "whoop" inspiration violent coughing fits--> emesis. Convalescent 3- Dec. s/s
Tx- Azithromycin/Clari/Erithro =< 1mth old
>2 mos old Septra (All exposed Prophy- Z pk 7-14)
Pertussis
143
ABnormal inflammation D2 Malassezia yeast. Capitis, axillae, groin, creases, dandruff
Tx- Ketoconazole, zinc, selenium sulfide, salicylic Acid
mineral oil, brush out scale and shampooing
Seborrheic Dermatitis (Skull cap)
144
Peak incidence=Adolescence. Initial Herald patch oval w central clearing @ breast, Torso or proximal thigh.
1-2 weeks later--> Generalized rash 0.2-2cm oval/oblong, ret or tan macules w fine, bran-like scale arranged parallel to skin lesion lines (Xmas tree pattern) Tx- AH1, phototherapy, Low Potency steroids
Pityriasis Rosea
145
Papulosquamous rash (well demarcated, scaling, erythematous, papules, and plaques) relapsing/chronic
Auspitz Sign Tx- Top Steroids, Vit. D, UV therapy, Immunosuppresives: Methotrexate, Cyclosporine, TNF-a Antagonists
Psoriasis
146
Scale removal resulting in pinpoint bleeding.
Auspitz Sign
147
skin surface exposed to irritating chemicals/substance
Urine/feces--> irritation buttocks region
Candida albicans or bacterial pathogens Tx: Topical Antifungal Nystatin and Miconazole (steroid)
Contact Dermatitis
148
Cell mediated immune rx (Type IV Hypersensitivity) plants, metal, fragrances, poison ivy/oak. bright pink pruritic patches. patches w clear vesicles or Bullae
Chronic- pink, scaly, pruritic plaques, intermittent exposure--> persistent dermatitis. TX- Top steroids AH1
Allergic Contact Dermatitis
149
Chronic inflammatory dz w/o cure. MC skin Dz in Children. Red. innate immune response. --> 2ndary Impetigo or Eczema Herpeticum
Inflamm. mediators involved Th1, Th2, langerhans Cells
Xerosis, pruritus, Erythamous paules or plaques overlying scales/ hyperkeratosis. 2ndary crust lechenification. Face/Extensor/AC/Flex areas/dorsum hands and feet. wrist, ankles and hands
Atopic Dermatitis
150
Atopic Dermatitis Tx-
Emollients- Following baths --> trap moisture (Not hot water)
Avoid Triggers-
AH1, Topical Corticosteroids- BID, Calcineurin IL- Inh. (Tacrolimus and Pimecrolimus)
151
Acute hypersensitivity syndrome. Abrupt onset, deep red well demarcated macules/papules target lesion.
3 concentric ring target lesion. Outer red, middle white, center dusky red r purple. MC HSV infx. S/S Tx
Erythema Multiforme
152
sudden red macules appearance, coalescing into large patches (Mostly face/trunk) Drug and Mycoplasma infx Prodrome of fever, HA, malaise, VD, Cough, vomiting
NSAID, Sulfonamides, anticonvulsants, and ABX. Viral, bacterial or fungal infx. @ any age. Nikolsky sign.
Steven-Johnson Syndrome (<10%)
Toxic Epidermic Necrolysis (>30% any mucosal surface)
153
MC skin D/O in adolescents, begins @ age 8 w 3 components; Hyperkeratinization, increased sebum, propionobacterium proliferation.
Acne Vulgaris
154
acne that includes blackheads: superficial plugging that opens to air
Non-inflammatory comodomes
155
Exists as pustules, papules, nodules or cysts. P. Acne colonization of comedomes.
Inflammatory Comodomes
156
Stage I Acne
(Comodomal acne)minimal papules no scarring
157
Stage II acne
(Papular acne) mild scarring w papules and pustules only
158
Stage III acne
(Acne) Extra facial and facial papules/pustules w moderate scarring and occasional cyst
159
Stage IV Acne
(Acne) Papules/pustules throughout w severe scarring and cyst are very common
160
Acne Tx-
Benzoyl Peroxide w/ top. Erythromycin/Clyndamycin *
| Top Tetracycline= yellow tinge skin and sunburn
Most effective PO Abx= Cystic lesions
161
Acne Tx- Isotretinoin (Accutane)- High dose vit. A requires what
Provider/Pt iPledge enrollment. 20 wk Tx. Severe Xerosis, X2 forms of contraception, hypertriglyceremia, hepatoxicity, bone marrow supp.
162
Other acne txs
OCP-Orthotricyclen (Low androgen/progestin component)
SPiranolactone (Yasmin/Yaz)- antiandrogenic
163
Eggs hatch in stomach and migrate to cecum to mature. at night migrate to anus (Pruritus Ani)
Eggs seen on microscope. (Enterobius Vermicularis)
Pinworm
164
Tx for pinworm
Albendazole Mebendazole, pyrantel pamoate single dose then at 2 weeks
165
Brown patches or plaques often w oval or lancet config. Resembles café au let initially. --> inc. darkness
changes in texture, elevation and may speckle. solitary neonatal nevi > 9cm or 6cm upto 20 cm on adulthood
Tx= 2Textensive deformity--> Sx
Congenital Melanocytic Nevi
166
Neuromelanosis (Melanocyte in CNS) are assoc. w
Giant Congenital Melanocytic Nevi
Hydrocephalus and Seizures
167
Well delineated round to oval, brown maculespapules. rapid growth, bleeding, change in borders = Bx
Indoor tanning in adolescence for malignant melanoma
Acquired nevi
168
Acquired benign vascular tumor commonly seen in children. Pink-red papules often arise post trauma.
Pedenculated, Grows rapidly, bright-red: traumatized bleeds profusely. Tx-Sx
Pyogenic Granuloma
169
Female burrows into epidermis and deposits her eggs. Highly contagious severe and paroxysmal itching
web spaces fingers and toes, axillae, groin, penis
Scabies
170
Scabies Tx
Tx- 12 hr overnight application of permethrin 5%, repeat tx 1 week later for hatched eggs.
Wash clothes in hot water/High heat dry. Seal in plastic bag X 7 days
171
scabies severe form in immunocompromised or Neurologically impaired persons. > 2 million bites
Norwegian (crusted) Scabies
172
Lice Tx body, head, groin.
1st Line Pyrethrin (Resistance on the rise)
2nd Line Malathion lotion (2nd Tx 10 days req.)
173
Poxvirus- 2-4 mm pearly flesh-colored or pink, nontender, dome shaped, w central umbilication
MC intertriginous regions. Toddlers and young children. Direct contact/Autoinoculation. Resolve in mos to years (Cyotherapy, Cantharidin Top., curettage)
Molluscum Contagiosum
174
Small dome shaped pustules or erythematous papules Staph A. Infx of hair follicles.
Tx- Superficial Antibacterial Chlorhexidine wash
Clindamycin 1% BID 7-10 days
Unresponsive cases--> PO Abx
Folliculitis
175
Infx of Sub-Q tissues and Epidermis. indurated, warm, erythematous macules w distinct borders.
Tx -Empiric Abx 1st Gen cephalosporin.
MRSA= Clindamycin/Septra
Cellulitis
176
P Aeruginosa pruritic papules, pustules or deeper purple red-nodules on skin covered by swimsuit
Folliculitis develops in 24-48 hrs post-exposure w/o systemic symptoms resolves in 1-2 weeks w/o Tx
Hot Tub Folliculitis
177
Deep hair follicle infx that manifest as nodules w intense surrounding inflamed rx.
Neck trunk, axillae, buttocks. Tx= I and D PO Abx
Furuncles (Boils)
178
Deepest of hair follicle infx characterized by multiseptate loculated abscesses Tx- InD PO Abx
Carbuncle
179
GAS (Strep) well demarcated tender, marked, perianal erythema extending 2cm from anus.
Pruritus and painful defecation w blood streak stools. Candidiasis, pinworm infx or anal fissures Tx PNC or Cefuroxime
Perianal Dermatitis
180
Common in children slightly pruritic ring like, erythematous plaques w scaling slow outward spread
Lifetime development of Dermatophysis 10-20%
Dx- KOH or fungal culture
Tinea Corporis/Capitis/Cruris/Pedis
181
Tx for Tinea corporis/Capitis/Cruris/Pedis
Topical antifungal creams Miconazole clotrimazole, ketoconazole, tolneftate
182
Oral Antifungals
Tx-Griseofulvin, Terbinafine, itraconazole (Capitis)
183
Tinea Unguium AKA __________
| Tx-
Onychomycosis
Confirm w KOH Tx- Terbinfafine, Itraconoazole
(12 weeks)--> Monitor LFTs
184
red- brown scaling patches. Hypo/Hyper pigmentation (Black) of skin in chest, back and or arms
Orange-Gold Fluorescence w wood/s lamp
Tinea Versicolor
185
Inflammatory reaction to tinea capitis. Swollen, boggy, crusted, purulent tender mass w LAD
Tx PO Antifungal + Steroid
Kerion
