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Phase II Pediatrics > Pediatrics 2 > Flashcards

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

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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

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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)

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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,

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5
Q

Retrosternal and epigastric pain. caused by GERD, medication, caustic chemicals, candida.

dx endoscopy-

A

Esophagitis

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6
Q

Tx Esophagitis

A

NPO and Iv fluids
Viscous lidocaine PPIs
Sucralfate Metoclopramide

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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

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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

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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

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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

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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)

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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

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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

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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

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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

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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)

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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)

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18
Q

Transmitted via contact w infected animals. chieckens, iguanas, reptiles, turtles. Dairy, eggs and poultry

A

Nontyphoidal salmonella

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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

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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

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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

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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

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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

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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)

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25
Q

Tx for Acute Gastroenteritis

A

Shigella- Cipro

Salmonella- Cipro (Ampicillin immune comp)

E. Coli- Cipro-Z pack (Not 0157)

C. Difficile and Giardia (Metronidazole)

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26
Q

Fluid resuscitation for kids and neonates

A

20ml/kg
10ml/kg Neonates (Give over 20 min, Both)

Both X3 boluses max then admit

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27
Q

Maintenance fluid therapy (D5W if maintenance)

A

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

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28
Q

autoimmune destruction of pancreatic islet cells (Beta cells) permanent insulin deficiency.

Polydipsia
polyuria
polyphagia

A

Diabetes Mellitus I

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29
Q

Dx of DMI or DM II

A

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

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30
Q

Acute MC complications of Diabetes Mellitus, Tx

A

Hypoglycemia

glucagon or IV Glucose

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31
Q

Physiologic GH release –>early am hyperglycemia that persists throughout night.

Tx increase PM insulin dose

A

Dawn Phenomenon (Common)

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32
Q

Toolarge night time insulin dose leads to early am hypoglycemia–>rebound hyperglycemia on waking

Tx- Decrease PM insulin

A

Somogyi Phenomenon

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33
Q

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

A

Diabetic Ketoacidosis

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34
Q

Dx and Tx

A

Serum Glucose 200-1,000, pH 7.3, Bicarb < 15

Tx- Fluids 1st, Insulin Iv- 0.1 U/kg/hr

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35
Q

Most serious complication of Diabetic Ketoacidosis

A

Cerebral Edema

Tx IV mannitol, ET/ventilate, subdural bolt

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36
Q

Peripheral resistance and compensatory hyperinsulinemia. pancreatic failure. obesity Afr. Amer.

Acanthosis Nigricans. Metabolic syndrome

A

DM II

Tx- Metformin 1st line

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37
Q

Group of dominantly inherited forms of mild diabetes
No insulin resistance.

Insufficient insulin secretory response to Glycemic stimulation. Tx sulfonylureas

A

Maturity-Onset Diabetes of youth (MODY)

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38
Q

Neonatal Renal disease Dx

A

UA/ Urine Cx (always w peds UA)

Ultrasound 1st Line

Voiding Cystourethrogram (VCUG)

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39
Q

Dx Modality for kidney structure and function

A

CT and MRI

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40
Q

Dx Modality observes reflux and evaluates urethra

repeated filling/emptying of bladder after radio dye

A

Voiding Cystourethrogram (VCUG)

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41
Q

Dx modality that evaluates kidney size, scars, and fx /excretion

A

Readionuclide studies

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42
Q

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

A

Urinary tract infection

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43
Q

UTI Dx

A

Pyuria> 50,000 older >100,000

Urine Luekocyte esterase and nitrate (70% sensiyive)

> 3-5 Epithelial cells = worry for validity of UA(Transurethral catheterization)

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44
Q

UTI Tx:

A

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

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45
Q

Investigation of UTI through imaging

A

Renal/Bladder US- All boys w UTI, girls <3 yoa,
3-7 yoa Girl >101.3

Abnormal US–> VCUG

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46
Q

retrograde urine flow from bladder up to the ureter or kidney. caused by congenital ureterovesical Jx incomp.

Cystitis or bladder obstruction–> intravesicular pressure.

A

Vesicoureteral Reflux (VUR)

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47
Q

Reflux into ureter, ,pelvis, and calyx w mild to moderate dilation or tortuosity of ureter pelvis

A

Grade III VUR

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48
Q

Moderate dilation /tortuosity of ureter /pelvis. complete obliteration of sharp angle of fornices

maintenance of papillary impression within calyx.

A

Grade IV VUR

Tx- Prophylactic Abx therapy
Dextranomer/hyaluronic acid copolymer
Sx

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49
Q

Gross dilation /tortuosity of ureter /pelvis w loss of papillary impressions in most calyces

A

Grade V VUR

Tx- Prophylactic Abx therapy
Dextranomer/hyaluronic acid copolymer
Sx

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50
Q

Reflux into ureter but does not extend to renal pelvis.

Reflux into ureter, pelvis, renal calyx but no dilation.

A

Grade I VUR

Grade II VUR (Both resolve w/o sx)

Tx- Dextranomer/hyaluronic acid copolymer

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51
Q

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,

A

Nephrotic Syndromes

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52
Q

Primary Nephrotic syndromes

A

Focal Glomerulosclerosis

Minimal Change

Membranoproliferative

Idiopathic membranous nephropathy

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53
Q

Absence of gross Hematuria*, MC form of its class. Responds well to steroids. (No renal Bx)

Renal insufficiency, HTN, hypocomplementemia
(Normal C3 Complement)

A

Minimal Change Nephrotic Syndrome

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54
Q

Less impressive proteinuria circulating factor affecting glomerular permeability found in some patients

Initially respond to steroids, but later build resistance

A

Primary Focal/Focal Segmental Glomerulosclerosis

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55
Q

Hypocomplementemia w signs of glomerular dz

High likelihood of kidney failure over time

A

Membranoproliferative Glomerulonephritis

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56
Q

MC in adolescents and children w systemic infections

HEP-B, Syphilis, malaria, toxoplasmosis, Gold Penicillamine

A

Idiopathic Membranous NS

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57
Q

Secondary nephrotic syndromes

A

SLE, Henoch-schonlein purpura, Wegener (Vasculitis)

Chronic infections (Hep-B/C, Malaria, HIV

Allergic reactions DM CHF Thrombosis

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58
Q

Nephrotic Syndrome Dx

A

Renal biopsy when Minimal Change NS not suspected

24 hr urine protein Low serum protein Albumin

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59
Q

Gross hematuria, proteinuria, edema, Oliguria, renal insufficiency

A

Glomerulonephritis

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60
Q

Glomerulonephritis types

A

Rapidly progressive Glomerulonephritis

Post-streptococcal Glomerulonephritis

Hereditary Nephritis (Alport Syndrome)

IgA Nephropathy (Berger’s)

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61
Q

X chromosome mutations in type IV collage–> abnormal glomerular basement membrane

Males: Renal failure and SNHL (Hearing)
Females: Microscopic hematuria (More benign course)

A

Hereditary Nephritis (Alport Syndrome)

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62
Q

MC chronic Glomerulonephritis. Microscopic/ recurrent Hematuria concurrent w URI. Inc risk for ESRD

Normal compliment levels. Renal Bx definitive

A

IgA Nephropathy (Berger’s Dz)

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63
Q

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

A

Post-Streptococcal Glomerulonephritis

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64
Q

Renal insufficiency progresses quickly and severely. Glomerular epithelial proliferation w crescents.

Early recognition crucial to prevent ESRD

A

rapidly Progressive Glomerulonephritis

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65
Q

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

A

Hemolytic Uremic Syndrome (HUS)

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66
Q

Hemolytic Uremic Syndrome (HUS) Tx

A

IV repletion HTN Control (95% recover)

Renal insufficiency–> Dialysis

Transfusions Abx/Andiarrheals–> HUS

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67
Q

Gene mutations resulting in cystic dysfx kidneys. MC inherited kidney dz. Polycystin 1 or 2 defects.

Hepatic, pancreatic, splenic, ovarian cysts. Middle adulthood

A

Polycystic Kidney Dz Autosomal Dominant

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68
Q

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

A

Polycystic Kidney Dz Autosomal Recessive

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69
Q

Produces no symptoms because collecting system develops normally and ureters enter the bladder

7% have Turner’s syndrome

A

Horeshoe Kidney

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70
Q

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

A

Renal Agenesis

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71
Q

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)

A

Testicular torsion

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72
Q

Testicular torsion Dx & Tx

A

Dx- US Doppler absent blood flow

Immediate Urology consult: Detorsion w/I 6 hrs

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73
Q

MC in premature infants. Can lead to testicular cancer 5X and infertility. If not accomplished by age 1 yoa refer

A

Cryptorchidism (Orchyplexy 2 yoa)

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74
Q

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

A

Hydrocele

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75
Q

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

A

Hypospadias (No circumcision)

76
Q

Decreases UTI risk in 1st year of life. Decreased phimosis/paraphimosis and dec. cancer risk

A

Circumcision

77
Q

primary- FMHX w no ID cause
Secondary- UTI, DM, D. Insipidus, Chronic COnstipation

Tx - Constipation cure, alarm (70% effective), Desmopressin, imipramine

A

Enuresis

78
Q

Definitive and TOC for cardiac abnormalities.

A

Echocardiography

79
Q

Functional benign murmurs

A

Still’s Murmur

Venous Hum

Pulmonic flow murmur

80
Q

Pathologic Murmurs

A

Systolic-AS PS, MR, MVP, TR, ASD, Syst

Sys/Dia- PDA (Throughout)

Diastolic- PR, AR, PS, TS S3, S4, VSD

81
Q

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

A

Ventricular septal Defect

82
Q

MC symptomatic pediatric dysrhythmia

A

supra Ventricular Tachycardia

83
Q

> = 3 consecutive PVCs

A

Ventricular Tachycardia

84
Q

Prolonged PR interval that is asymptomatic

Tx-

A

1st degree Heart Block

85
Q

Progressive PR Interval prolongation until QRS dropped Going going gone

PR interval Unchanged QRS dropped
Tx

A

2nd Degree Type I (No Eval/Tx)

2nd Degree type II (Pacemaker)

86
Q

No relationship between atrial and ventricular activity

A

3rd degree HB (Intervene)

87
Q

Opening between right and left atrium allowing for a R-L shunt prostaglandin E maintains open

A

Foramen Ovale

88
Q

Opening between the pulmonary artery and aorta allowing for a R-L shunt

A

Ductus areteriosus

89
Q

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

A

Atrial Septal Defect (Present @ age 3= Sx closure)

90
Q

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-

A

Patent Ductus Arteriosus (Indomethacin)

91
Q

Exertional Dyspnea and fatigability Rough Systolic w ejection click LUSB Radiates to back /RUSBRadiates to neck.

Tx Valvuplasty – Sx if fails

A

Aortic Stenosis (Aortic Dilation)

Pulmonary stenosis (Pulmonary Artery dilation)

92
Q

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

A

Coarctation of the aorta

93
Q

Cyanotic Lesions 5 Ts

A

Tetralogy of Fallot

Transportation of the great vessels

Tricuspid Atresia

Truncus Arteriosus

Total Anomalous Venous Return

94
Q

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

A

Tetralogy of Fallot

95
Q

Tetralogy of Fallot 4 cardinals

A
  • Overriding Aorta
  • Pulmonary Stenosis
  • VSD
  • RVH
96
Q

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

A

Transposition of the Great vessels

97
Q

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

A

Tricuspid Atresia

98
Q

Failure of septation of truncus- single arterial trunk that contains Aorta and Pulmonary artery. VSD present

Tx sx repair

A

Truncus Arteriosus

99
Q

Pulmonary veins fail to connect to LA. If ASD not present= not life compatible. Tx- Sx repair

A

Total Anomalous Venous return

100
Q

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

A

Hypoplastic Left Heart syndrome

101
Q

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

A

Ebstein’s Anomaly

102
Q

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

A

Rheumatic Fever

Long term Tx- Bicillin q 28 days lifetime w valve defects

103
Q

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

A

Pericarditis

104
Q

Dx-Tx Pericarditis

A

Globular cardiac silhouette (Water Bottle sign)

EKG- Reduced QRS voltage N Electrical Alternans

(Pericardiocentesis NSAIDS)

105
Q

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.

A 
Infective Endocarditis
(Prophylaxis all dental procedures Amox)
106
Q

Primary HTN MC ?

Secondary HTN MC Cause

Tx

A

Primary- MC Obese MC cause in adolescents

Secondary- Renal Dz (More severe Elevated)

CCBs or ACEi

107
Q

Fixation and visual tracking occurs at what age?

Eye alignment should be complete by?

Visual Acuity and fundal exam by what age?

A

6 wks old

4mos

3 YOA

108
Q

unilateral or bilateral central vision loss due to inappropriate visual development.

A

Amblyopia

109
Q

neonatal conjunctivitis:

Day 1-3?
Day 2-7 ?
Day 3-21 ?

A

1-3 Chemical

2-7 Staph, strep, Pseudomonas, E.coli

3-21 HSV

110
Q

Neonatal conjunctivitis

Chlamydia?

Gonorrhea

S. Aureus

Pseudomonas

A

Chlamydia- Erythromycin 14 days

Gonorrhea- Ceftriaxone single dose 25-50mg/kg

S. Aureus - erythromycin

Pseudomonas- Fluoroquinolones

111
Q

Pre-auricular node, watery scant mucoid DC, mainly adenovirus 8-19. Follicular* response, Moderate -severe

A

Conjunctivitis Viral

112
Q

Pruritus,watery DC, eyelid edema w cobble stoning, Blebs, Tx AH1, NSAID

A

Allergic conjunctivitis

113
Q

Eyelid margin inflammation DT S. Aureus. Seborrhea or Meibomian gland dysfunction. Tx baby shampoo

Erythromycin, warm compresses

A

Blepharitis

114
Q

Tear duct blockage. complete obstruction. May progress to orbital cellulitis.

Tx- warm compresses and topical Abx

A

Dacryocystitis- Acute

Dacryostenosis- Chronic (Partial Blockage)

115
Q

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

A

Hordeolum (Stye)

116
Q

Meibomian gland obstruction granulomatous gland inflammation. wks-mos. Tx ophtho steroid inj.

A

Chalazion

117
Q

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

A

Orbital Cellulitis

118
Q

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.

A

Acute Otitis Media

119
Q

if recurrent less than 1 month of tx
if recurrent more than 1 month of tx

when to refer to ENT

A

change Abx
Same Abx

> 3 episodes in 6 mos or >4 episodes in 12 mos
Persistent effusion > 3mos

120
Q

Posterior auricular tenderness/swelling/erythema + otitis media signs. pinna displaced down/outward

Systemic abx and ENT. Drainage if abscess formation

A

Mastoiditis

121
Q

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

A

Otitis Externa (Swimmer’s Ear)

122
Q

Common Cold MC Virus

A

Rhinovirus, Corona, RSV

Otitis Media MC complication.

123
Q

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)

A

Sinusitis (Tx AugmentinX14 days)

124
Q

Atopic triad

A

Eczema, asthma, allergic rhinitis

125
Q

thin rhinorrhea, nasal congestion, eye pruritic, cobblestoning, allergic shiners, transverse nasal crease.

Nasal turbinate bogginess/pallor/clear watery secretions

A

Allergic rhinitis (Nasonex Flonase)

126
Q

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

A

Pharyngitis/Tonsilitis (Bicillin Pen V or Azithromycin)

127
Q

harsh sound caused by partially obstructed airway. Commonly heard during inspiration

A

Stridor (MC Laryngomalacia Floppy larynx)

128
Q

partial obstruction of the lower airways. MC heard during expiration. Low pitch- Central High- peripheral

A

Wheezing

129
Q

Irregular course rattling due to secretions in intrathoracic airways.

A

Rhonchi

130
Q

Fluid secretions in small airways produces sound like crumpling cellophane

A

Rales

131
Q

Narrowest portion of the airway < 3 yoa

Narrowest portion of airway older children adults?

A

Cricoid ring

Glottis

132
Q

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

A

Croup

133
Q

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.

A

Epiglottitis (Tx-Abx ET tube)

134
Q

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

A

Asthma (<5 yo trial of Rx=Dx)

135
Q

Peak Flow meter for asthma.

Every symptomatic patient and annually in office X 3 readings.

A

PEF<50%= Immediate Tx (Red Zone)

PEF 50-79%= Inc. Dose or Add Rx

80-100%= asymptomatic continue regimen

136
Q

Inhaler that causes anxiousness, tremor, racing heart, transient mild hypokalemia. W spacer

A

Albuterol

137
Q

Adjunct if minimal improvement after albuterol

A

Ipatropium

138
Q

Greatest benefit shorten duration for acute exacerbation “burst therapy” reduces urgent care/ER

A

Prednisone 1-2 mg/kg Oral Parenteral

139
Q

1st line medication for persistent asthma. Reduces comorbidity, airway hyperreactivity, rescue inhaler therapy, hospitalization, death. –> thrush hoarse voice

A

Inhaled Corticosteroids

140
Q

Modest efficacy alone or in combo w inhaled steroid. Effective in exercise induced asthma

A

Montelukast (Leukotriene Rec.)

141
Q

Long acting muscle relaxant 12 hrs. Used in combo w inhaled steroid for chronic asthma management.

A

LABA Long Acting Beta Agonist

142
Q

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)

A

Pertussis

143
Q

ABnormal inflammation D2 Malassezia yeast. Capitis, axillae, groin, creases, dandruff

Tx- Ketoconazole, zinc, selenium sulfide, salicylic Acid
mineral oil, brush out scale and shampooing

A

Seborrheic Dermatitis (Skull cap)

144
Q

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

A

Pityriasis Rosea

145
Q

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

A

Psoriasis

146
Q

Scale removal resulting in pinpoint bleeding.

A

Auspitz Sign

147
Q

skin surface exposed to irritating chemicals/substance
Urine/feces–> irritation buttocks region

Candida albicans or bacterial pathogens Tx: Topical Antifungal Nystatin and Miconazole (steroid)

A

Contact Dermatitis

148
Q

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

A

Allergic Contact Dermatitis

149
Q

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

A

Atopic Dermatitis

150
Q

Atopic Dermatitis Tx-

A

Emollients- Following baths –> trap moisture (Not hot water)

Avoid Triggers-

AH1, Topical Corticosteroids- BID, Calcineurin IL- Inh. (Tacrolimus and Pimecrolimus)

151
Q

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

A

Erythema Multiforme

152
Q

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.

A

Steven-Johnson Syndrome (<10%)

Toxic Epidermic Necrolysis (>30% any mucosal surface)

153
Q

MC skin D/O in adolescents, begins @ age 8 w 3 components; Hyperkeratinization, increased sebum, propionobacterium proliferation.

A

Acne Vulgaris

154
Q

acne that includes blackheads: superficial plugging that opens to air

A

Non-inflammatory comodomes

155
Q

Exists as pustules, papules, nodules or cysts. P. Acne colonization of comedomes.

A

Inflammatory Comodomes

156
Q

Stage I Acne

A

(Comodomal acne)minimal papules no scarring

157
Q

Stage II acne

A

(Papular acne) mild scarring w papules and pustules only

158
Q

Stage III acne

A

(Acne) Extra facial and facial papules/pustules w moderate scarring and occasional cyst

159
Q

Stage IV Acne

A

(Acne) Papules/pustules throughout w severe scarring and cyst are very common

160
Q

Acne Tx-

A

Benzoyl Peroxide w/ top. Erythromycin/Clyndamycin *

Top Tetracycline= yellow tinge skin and sunburn
Most effective PO Abx= Cystic lesions

161
Q

Acne Tx- Isotretinoin (Accutane)- High dose vit. A requires what

A

Provider/Pt iPledge enrollment. 20 wk Tx. Severe Xerosis, X2 forms of contraception, hypertriglyceremia, hepatoxicity, bone marrow supp.

162
Q

Other acne txs

A

OCP-Orthotricyclen (Low androgen/progestin component)

SPiranolactone (Yasmin/Yaz)- antiandrogenic

163
Q

Eggs hatch in stomach and migrate to cecum to mature. at night migrate to anus (Pruritus Ani)

Eggs seen on microscope. (Enterobius Vermicularis)

A

Pinworm

164
Q

Tx for pinworm

A

Albendazole Mebendazole, pyrantel pamoate single dose then at 2 weeks

165
Q

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

A

Congenital Melanocytic Nevi

166
Q

Neuromelanosis (Melanocyte in CNS) are assoc. w

A

Giant Congenital Melanocytic Nevi

Hydrocephalus and Seizures

167
Q

Well delineated round to oval, brown maculespapules. rapid growth, bleeding, change in borders = Bx

Indoor tanning in adolescence for malignant melanoma

A

Acquired nevi

168
Q

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

A

Pyogenic Granuloma

169
Q

Female burrows into epidermis and deposits her eggs. Highly contagious severe and paroxysmal itching

web spaces fingers and toes, axillae, groin, penis

A

Scabies

170
Q

Scabies Tx

A

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
Q

scabies severe form in immunocompromised or Neurologically impaired persons. > 2 million bites

A

Norwegian (crusted) Scabies

172
Q

Lice Tx body, head, groin.

A

1st Line Pyrethrin (Resistance on the rise)

2nd Line Malathion lotion (2nd Tx 10 days req.)

173
Q

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)

A

Molluscum Contagiosum

174
Q

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

A

Folliculitis

175
Q

Infx of Sub-Q tissues and Epidermis. indurated, warm, erythematous macules w distinct borders.

Tx -Empiric Abx 1st Gen cephalosporin.
MRSA= Clindamycin/Septra

A

Cellulitis

176
Q

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

A

Hot Tub Folliculitis

177
Q

Deep hair follicle infx that manifest as nodules w intense surrounding inflamed rx.

Neck trunk, axillae, buttocks. Tx= I and D PO Abx

A

Furuncles (Boils)

178
Q

Deepest of hair follicle infx characterized by multiseptate loculated abscesses Tx- InD PO Abx

A

Carbuncle

179
Q

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

A

Perianal Dermatitis

180
Q

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

A

Tinea Corporis/Capitis/Cruris/Pedis

181
Q

Tx for Tinea corporis/Capitis/Cruris/Pedis

A

Topical antifungal creams Miconazole clotrimazole, ketoconazole, tolneftate

182
Q

Oral Antifungals

A

Tx-Griseofulvin, Terbinafine, itraconazole (Capitis)

183
Q

Tinea Unguium AKA __________

Tx-

A

Onychomycosis

Confirm w KOH Tx- Terbinfafine, Itraconoazole
(12 weeks)–> Monitor LFTs

184
Q

red- brown scaling patches. Hypo/Hyper pigmentation (Black) of skin in chest, back and or arms

Orange-Gold Fluorescence w wood/s lamp

A

Tinea Versicolor

185
Q

Inflammatory reaction to tinea capitis. Swollen, boggy, crusted, purulent tender mass w LAD

Tx PO Antifungal + Steroid

A

Kerion

Phase II Pediatrics (3 decks)

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