Pediatrics Exam 2 Flashcards
Congenital Melanocytic Nevi
Definition
proliferation of benign melanocytes
Congenital Melanocytic Nevi
Presentation
- Macules, papules, plaques present at birth
- +/- hair
- may change w/ time
- grow in proportion to size
Congenital Melanocytic Nevi
Malignancy risk
- Small/medium CMN have < 1% risk of malignancy
- Large/Giant lesions 0-7.6% risk. Avg. is 2%
Mongolian Spot
Definition
Congenital Dermal Melanocytosis
Mongolian Spot
Presentation
- Most common pigmented lesion in infants. fade by 2 y/o, disappear by 10
- bluish-grey patch
- irregular border and normal texture
- buttocks, low back
- Asian, black, hispanic
- Present at birth, evident in 1st weeks
Nevus Sebaceous
Definition
- hyperplasia of epidermis, sebaceous glands, hair follicles, apocrine glands
Nevus Sebaceous
(Presentation
- scalp/face
- waxy, solitary, smooth, yellow-orange, hairless
- oval/linear
- more pronounced in adolescence
Nevus Sebaceous
Dx
- atypical = histological eval
2. BCC or other malignancy may arise from lesion
Nevus Sebaceous
Tx
- only if concerning changes observed
Aplasia Cutis Congenita
Definition
- absence of skin present at birth
2. localized or widespread
Aplasia Cutis Congenita
presentation
- midline, posterior scalp
- +/- bulla
- +/- other dev abnormalities
- well demarcated
Aplasia Cutis Congenita
Tx
- size, depth, location dependant
- gentle cleansing, ointment
- hypertrophic scarring
- neurosug referr for large/multiple defects
Cafe-Au-Lait Macules
Presentation
- Discrete, uniformly pigmented macules/patches
- M/c in AA, hisp, asian, white
- present at birth, early childhood
- associated w/ macune-albright or NF1
NF1
- cafe-au-lait macules
- axillary/inguinal freckling
- neurofibromas
- lisch nodules
- optic gliomas
Port-Wine Stain
Definition
- cutaneous capillary malformation
Port-Wine Stain
Presentation
- present at birth, no regression
- pink, dark red patches that may get darker
- associated c soft tissue, bony overgrowth. sturge weber syndrome, congenital glaucoma
Port-Wine Stain
Management
- depends on size, location, cosmetic impact
- pulse dye laser: intravascular coagulation
- Vascular specialist if widespread
Infantile Hemangioma
Definition
- common benign vascular tumor
2. Risk factors: low birth weight, female, twins, fair skin
Infantile Hemangioma
Presentation
- appears shortly after birth
- superficial, deep or mixed: superficial = bright read, deep = bluish border
- Ulceration common complication
Infantile Hemangioma
Progression
- proliferative phase: Early
- rapid growth during 1st 3 months - Proliferative phase: late
- less rapid, still ongoing
- completed typically by 9 mo - Involution Phase: color darkens, tumor softens.
Nevus Simplex
Presentation
- faint, transient
- flat, pink/red patch
- midline forehead, scalp, upper eyelids, posterior neck and back
- “stork bite” or “angel kiss”
- most common pediatric vascular lesion
- fade w/in 1-2 years
Pyogenic Granuloma
presentation
- acquired lobular vascular tumor
- hands, fingers, face, mucous membranes
- develop rapidly
- extremely friable
- recur despite tx
Pyogenic Granuloma
Tx
- biopsy to confirm dx
- surgical excision w/ primary closure - high risk of recurrence, tx is traumatic
Diaper Dermatitis
Definition
- irritant/contact dermatitis
2. may be caused by seborrheic dermatitis, atopic dermatitis
Diaper Dermatitis
Pathogenesis
- excessive moisture, friction, increased pH
2. macerated skin, infx from urine/feces
Diaper dermatitis
Presentation
- Episodic, varying severity
- candidal superinfection: beefy red plaques in intertriginous regions
- Impetigo: s. aureus/pyogenes. fragile honey crusted pustules/erosions
Diaper Dermatitis
prevention
- frequent diaper changes
- air exposure
- gentle cleansing
- fragrance free baby wipes
Diaper Dermatitis
Tx
- OTC pasts, ointments
- low-potency topical CS
- breast milk
- antifungals
- topical/systemic abx
Neonatal Cephalic Pustulosis
- Not true acne - malassezia colonization
- self-limited
- present first 2-3 weeks, resolves by 6-12 months
Neonatal acne
Presentation & Tx
- no comedones
- Presents w/ papules pustules on forehead, nose cheeks
Tx: mild cleansing w/ soap and water.
Ketoconazole, hydrocortisone
Resolves by 4 mo
Infantile Acne
Presentation
Presents at 3-4 mo, resolves by 2-3 y/o
hyperplasia of sebaceous glands
papules, pustules, comedones
Infantile Acne
management
benzoyl peroxide, topical abx, topical retinoids
oral tx in severe cases
What differentiates periosteum in pediatric pts?
More metabolically active
thicker and more durable
Common fx types in pediatric patients?
buckle/torus, greenstick, bowing
CRITOE, 1, 3, 5, 7, 9, 11
1 - Capitulum
3 - Radial Head
5 - Internal epicondyle
7 - trochlea
9 - olecranon
11 - external epicondyle
Most common elbow fracture, occurs under 10 y/o.
MOI: FOOSH from moderate height (monkey bars)
Swelling, Pain, +/- deformity
Supracondylar humeral fx
NV exam critical to asses median nerve
Diagnostics for supracondylar fx
X Ray: AP, lateral, oblique. Ant. humeral line should intersect capitulum
Supracondylar fx management
Type I/II: splint w/ light overwrap.
Type III/NV concerns: emergent ortho consult. CRPPF
Concentrated soft tissue swelling at lateral elbow
Tender palpation over lateral condyle
X-Ray shows small Fx
Lateral humeral condyle fx
Lateral humeral condyle fx diagnostics
X-Ray: AP, lateral, internal oblique
+/- MRI
Management of lateral humeral condyle fx
- splint, sling, NSAIDs
- Emergent ortho consult if displaced >2mm on internal oblique view
- Immobilization via cast or ORIF
High risk of complications
MOI: muscle attachment avulsion from throwing athletes/gymnasts, FOOSH, posterior elbow dislocation
Presents w/ local pain, pain w/ resisted wrist flexion, ulnar nerve dysfunction
Medial Humeral Epicondyle Fx
Diagnostics for medial humeral epicondyle fx
X-Ray: AP, lateral, external oblique.
Rule out incarceration of fragment in joint
Management of medial epicondyle fx
- emergent if entrapped fragment
- Splint w/ wrist and sling
- NSAIDs
Complications of medial epicondyle fx
ulnar n. injury
nonunion
angular deformity
decreased ROM
MOI: FOOSH w/ valgus stress, posterior elbow dislocation
Presents w/:
- tenderness over radial head/neck
- pain w/ supination/pronation more than flexion/extension
- young children may complain of wrist pain
Radial neck fx
Diagnostics for radial neck fx
X-Ray: AP, lateral and external oblique
Clinical if radial head not ossified (3-5 years)
Management of radial neck fx
immobilization including wrist.
sling
NSAIDs
Cast v. surgery
complications of radial neck fx
premature physeal closure
loss of ROM
nonunion
Subluxation of radial head between age 1 and 3
MOI: sudden pull of pronated arm.
Presents w/:
- fully extended, pronated arm
- won’t use arm, but will use fingers
- pain over radial head, increased w/ supination
Nursemaid’s elbow
Management of nursemaid’s elbow
- reduction via hyperpronation or supination/flexion
2. f/u w/ lollipop test
MOI: FOOSH, direct trauma
Common on distal radius at metaphysis +/- ulnar involvement
Presents w/:
-point tenderness, swelling, ecchymosis
Wrist fx
Diagnostics for wrist fx
X-Ray: AP/Lat +/- oblique
SH I clinical diagnosis
Management of wrist fx
emergent w/ significant deformity or N/V compromise
Splint and NSAIDs
Ortho: cast, +/- reduction/surgery
Trauma, pain in groin/buttock
NWB, non-ambulatory
leg helt in slight adduction w/ external rotation
may see shortening of limb
Femur fx
Diagnostics for femur fx
X-Ray entire length of femur
management of femur fx
hip spica cast or surgery
complications of femur fx
shortening, lengthening, angulation deformity
Unique fx to children, post common in kids < 13 y/o
MOI: forced extension w/ knee if flexion (jumping, kicking
Presents at superior or inferior pole of patella
special fx of the patella/patellar sleeve fx
management of patellar sleeve fx
knee immobilizer
nwb
elevation
nsaids
ortho: cast v. surgery
MOI: falling while running/twisting motion. Slides
Presents w/:
- limp or refusal to weight bear
- presumed foot injury
- pain w/ palpation along tibia mid to distal diaphysis
Toddler fx
diagnostics for toddler fx
X-Ray: AP, lateral, obliques
MGMT of toddler fx
immobilization
nwb
nsaids
elevation
Ortho: wee walker vs casting
MOI: external rotation
Presents w/:
-Type III on AP, type II on lateral = type IV
triplane fx
management of triplane fx
must get CT.
Ortho: surgical fixation vs closed reduction
posterior or stirrup splint
elevation, nwb, nsaids
PT
Scoliosis degree of curvature and common ages
greater than 10 degree curve
Adolescent 10 or older
Physical exam for scoliosis
- shoulder or pelvic obliquity
- asymmetry of scapulae
- adam’s forward flexion exam
Imaging for scoliosis
cobb angle analysis
AP/PA standing plain radiograph on long cassette
Tx for scoliosis
boston, milwaukee, charleston bending braces
Surger indicated if 45 degrees
Age : 0-3mo or 3-6 y/o
male prevalence greater than female
hx of trauma or surgery
appears toxic w/ fever, monoarticular pain exacerbated w/ passive ROM, nwb
Septic hip
Age 3-8 y/o, male
afebrile, well appearing
pain worse in am, improves during day
hx of recent uri
transient synovitis
Kocher criteria
- wbc > 12k
- ESR > 40
- Fever > 101.3
- nwb on affected side
2/4 warrants joint aspiration for septic hip
Imaging for septic hip
X-Ray: AP, frog-leg and lateral pelvic
Ultrasound: effusion and aspiration
MRI
management of septic hip
EMERGENT
Surgical I & D, joint aspiration is diagnostic
Abx: Cephalosporins
If n. gonorrhoeae, high dose penicillin
pt. 4-8 y/o, male
Dx w/ ADHD
Presents w/:
- painless limp at end of day
- muscle spasticity
- Hx of minor trauma
Exam reveals:
- antalgic limp/trendelenburg gait
- limited internal rotation/abduction of hip
- galeazzi
Perthes
Imaging for Perthes
X-Ray: AP and frog laterals
Bone scan/MRI
Tx of perthes
younger age = better outcome
control of sxs and hip preservation
- Male pt, between 10-16 y/o
- Obese, limp or nwb w/ hip or knee pain
- Restricted ROM, abduction and internal rotation
Slipped Capital Femoral Epiphysis (SCFE)
“Ice cream slipping off the cone”
Diagnostics for SCFE
X-Ray: AP Pelvis and Frog Lateral
MRI if suspected but neg x-rays
Tx of SCFE
urgent surgical consult
if NWB, admit to hospital
Female, 1st born, breach pt.
presents w/ laxity, subluxation and dislocation of hip
+ barlow and ortolani w/ clunking sensation
+galeazzi
developmental dysplasia of the hip
Management of DDH
Pavlik harness via ortho clinic
avoid swaddling and tight fitting clothes
monitor
X-Ray after 6-7 mo
Fixed deformity.
midfoot = cavus forefoot = adducts hindfoot = varus hindfoot = equinus
fhx, maternal smoking
clubfoot, congenital talipes equinovarus
Tx of clubfoot
ponseti casting
