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Clinical Medicine I > Pediatrics Exam 2 > Flashcards

Pediatrics Exam 2 Flashcards

1
Q

Congenital Melanocytic Nevi

Definition

A

proliferation of benign melanocytes

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2
Q

Congenital Melanocytic Nevi

Presentation

A
  • Macules, papules, plaques present at birth
  • +/- hair
  • may change w/ time
  • grow in proportion to size
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3
Q

Congenital Melanocytic Nevi

Malignancy risk

A
  • Small/medium CMN have < 1% risk of malignancy

- Large/Giant lesions 0-7.6% risk. Avg. is 2%

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4
Q

Mongolian Spot

Definition

A

Congenital Dermal Melanocytosis

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5
Q

Mongolian Spot

Presentation

A
  • 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
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6
Q

Nevus Sebaceous

Definition

A
  1. hyperplasia of epidermis, sebaceous glands, hair follicles, apocrine glands
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7
Q

Nevus Sebaceous

(Presentation

A
  1. scalp/face
  2. waxy, solitary, smooth, yellow-orange, hairless
  3. oval/linear
  4. more pronounced in adolescence
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8
Q

Nevus Sebaceous

Dx

A
  1. atypical = histological eval

2. BCC or other malignancy may arise from lesion

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9
Q

Nevus Sebaceous

Tx

A
  1. only if concerning changes observed
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10
Q

Aplasia Cutis Congenita

Definition

A
  1. absence of skin present at birth

2. localized or widespread

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11
Q

Aplasia Cutis Congenita

presentation

A
  1. midline, posterior scalp
  2. +/- bulla
  3. +/- other dev abnormalities
  4. well demarcated
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12
Q

Aplasia Cutis Congenita

Tx

A
  1. size, depth, location dependant
  2. gentle cleansing, ointment
  3. hypertrophic scarring
  4. neurosug referr for large/multiple defects
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13
Q

Cafe-Au-Lait Macules

Presentation

A
  1. Discrete, uniformly pigmented macules/patches
  2. M/c in AA, hisp, asian, white
  3. present at birth, early childhood
  4. associated w/ macune-albright or NF1
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14
Q

NF1

A
  1. cafe-au-lait macules
  2. axillary/inguinal freckling
  3. neurofibromas
  4. lisch nodules
  5. optic gliomas
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15
Q

Port-Wine Stain

Definition

A
  1. cutaneous capillary malformation
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16
Q

Port-Wine Stain

Presentation

A
  1. present at birth, no regression
  2. pink, dark red patches that may get darker
  3. associated c soft tissue, bony overgrowth. sturge weber syndrome, congenital glaucoma
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17
Q

Port-Wine Stain

Management

A
  1. depends on size, location, cosmetic impact
  2. pulse dye laser: intravascular coagulation
  3. Vascular specialist if widespread
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18
Q

Infantile Hemangioma

Definition

A
  1. common benign vascular tumor

2. Risk factors: low birth weight, female, twins, fair skin

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19
Q

Infantile Hemangioma

Presentation

A
  1. appears shortly after birth
  2. superficial, deep or mixed: superficial = bright read, deep = bluish border
  3. Ulceration common complication
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20
Q

Infantile Hemangioma

Progression

A
  1. proliferative phase: Early
    - rapid growth during 1st 3 months
  2. Proliferative phase: late
    - less rapid, still ongoing
    - completed typically by 9 mo
  3. Involution Phase: color darkens, tumor softens.
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21
Q

Nevus Simplex

Presentation

A
  1. faint, transient
  2. flat, pink/red patch
  3. midline forehead, scalp, upper eyelids, posterior neck and back
  4. “stork bite” or “angel kiss”
  5. most common pediatric vascular lesion
  6. fade w/in 1-2 years
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22
Q

Pyogenic Granuloma

presentation

A
  1. acquired lobular vascular tumor
  2. hands, fingers, face, mucous membranes
  3. develop rapidly
  4. extremely friable
  5. recur despite tx
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23
Q

Pyogenic Granuloma

Tx

A
  1. biopsy to confirm dx
    - surgical excision w/ primary closure
  2. high risk of recurrence, tx is traumatic
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24
Q

Diaper Dermatitis

Definition

A
  1. irritant/contact dermatitis

2. may be caused by seborrheic dermatitis, atopic dermatitis

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25
Q

Diaper Dermatitis

Pathogenesis

A
  1. excessive moisture, friction, increased pH

2. macerated skin, infx from urine/feces

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26
Q

Diaper dermatitis

Presentation

A
  1. Episodic, varying severity
  2. candidal superinfection: beefy red plaques in intertriginous regions
  3. Impetigo: s. aureus/pyogenes. fragile honey crusted pustules/erosions
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27
Q

Diaper Dermatitis

prevention

A
  1. frequent diaper changes
  2. air exposure
  3. gentle cleansing
  4. fragrance free baby wipes
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28
Q

Diaper Dermatitis

Tx

A
  1. OTC pasts, ointments
  2. low-potency topical CS
  3. breast milk
  4. antifungals
  5. topical/systemic abx
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29
Q

Neonatal Cephalic Pustulosis

A
  1. Not true acne - malassezia colonization
  2. self-limited
  3. present first 2-3 weeks, resolves by 6-12 months
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30
Q

Neonatal acne

Presentation & Tx

A
  1. no comedones
  2. Presents w/ papules pustules on forehead, nose cheeks

Tx: mild cleansing w/ soap and water.

Ketoconazole, hydrocortisone

Resolves by 4 mo

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31
Q

Infantile Acne

Presentation

A

Presents at 3-4 mo, resolves by 2-3 y/o

hyperplasia of sebaceous glands

papules, pustules, comedones

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32
Q

Infantile Acne

management

A

benzoyl peroxide, topical abx, topical retinoids

oral tx in severe cases

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33
Q

What differentiates periosteum in pediatric pts?

A

More metabolically active

thicker and more durable

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34
Q

Common fx types in pediatric patients?

A

buckle/torus, greenstick, bowing

35
Q

CRITOE, 1, 3, 5, 7, 9, 11

A

1 - Capitulum

3 - Radial Head

5 - Internal epicondyle

7 - trochlea

9 - olecranon

11 - external epicondyle

36
Q

Most common elbow fracture, occurs under 10 y/o.

MOI: FOOSH from moderate height (monkey bars)

Swelling, Pain, +/- deformity

A

Supracondylar humeral fx

NV exam critical to asses median nerve

37
Q

Diagnostics for supracondylar fx

A

X Ray: AP, lateral, oblique. Ant. humeral line should intersect capitulum

38
Q

Supracondylar fx management

A

Type I/II: splint w/ light overwrap.

Type III/NV concerns: emergent ortho consult. CRPPF

39
Q

Concentrated soft tissue swelling at lateral elbow

Tender palpation over lateral condyle

X-Ray shows small Fx

A

Lateral humeral condyle fx

40
Q

Lateral humeral condyle fx diagnostics

A

X-Ray: AP, lateral, internal oblique

+/- MRI

41
Q

Management of lateral humeral condyle fx

A
  • splint, sling, NSAIDs
  • Emergent ortho consult if displaced >2mm on internal oblique view
  • Immobilization via cast or ORIF

High risk of complications

42
Q

MOI: muscle attachment avulsion from throwing athletes/gymnasts, FOOSH, posterior elbow dislocation

Presents w/ local pain, pain w/ resisted wrist flexion, ulnar nerve dysfunction

A

Medial Humeral Epicondyle Fx

43
Q

Diagnostics for medial humeral epicondyle fx

A

X-Ray: AP, lateral, external oblique.

Rule out incarceration of fragment in joint

44
Q

Management of medial epicondyle fx

A
  • emergent if entrapped fragment
  • Splint w/ wrist and sling
  • NSAIDs
45
Q

Complications of medial epicondyle fx

A

ulnar n. injury
nonunion
angular deformity
decreased ROM

46
Q

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
A

Radial neck fx

47
Q

Diagnostics for radial neck fx

A

X-Ray: AP, lateral and external oblique

Clinical if radial head not ossified (3-5 years)

48
Q

Management of radial neck fx

A

immobilization including wrist.

sling

NSAIDs

Cast v. surgery

49
Q

complications of radial neck fx

A

premature physeal closure

loss of ROM

nonunion

50
Q

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
A

Nursemaid’s elbow

51
Q

Management of nursemaid’s elbow

A
  1. reduction via hyperpronation or supination/flexion

2. f/u w/ lollipop test

52
Q

MOI: FOOSH, direct trauma

Common on distal radius at metaphysis +/- ulnar involvement

Presents w/:
-point tenderness, swelling, ecchymosis

A

Wrist fx

53
Q

Diagnostics for wrist fx

A

X-Ray: AP/Lat +/- oblique

SH I clinical diagnosis

54
Q

Management of wrist fx

A

emergent w/ significant deformity or N/V compromise

Splint and NSAIDs

Ortho: cast, +/- reduction/surgery

55
Q

Trauma, pain in groin/buttock

NWB, non-ambulatory

leg helt in slight adduction w/ external rotation

may see shortening of limb

A

Femur fx

56
Q

Diagnostics for femur fx

A

X-Ray entire length of femur

57
Q

management of femur fx

A

hip spica cast or surgery

58
Q

complications of femur fx

A

shortening, lengthening, angulation deformity

59
Q

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

A

special fx of the patella/patellar sleeve fx

60
Q

management of patellar sleeve fx

A

knee immobilizer
nwb
elevation
nsaids

ortho: cast v. surgery

61
Q

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
A

Toddler fx

62
Q

diagnostics for toddler fx

A

X-Ray: AP, lateral, obliques

63
Q

MGMT of toddler fx

A

immobilization
nwb
nsaids
elevation

Ortho: wee walker vs casting

64
Q

MOI: external rotation

Presents w/:
-Type III on AP, type II on lateral = type IV

A

triplane fx

65
Q

management of triplane fx

A

must get CT.
Ortho: surgical fixation vs closed reduction

posterior or stirrup splint
elevation, nwb, nsaids
PT

66
Q

Scoliosis degree of curvature and common ages

A

greater than 10 degree curve

Adolescent 10 or older

67
Q

Physical exam for scoliosis

A
  • shoulder or pelvic obliquity
  • asymmetry of scapulae
  • adam’s forward flexion exam
68
Q

Imaging for scoliosis

A

cobb angle analysis

AP/PA standing plain radiograph on long cassette

69
Q

Tx for scoliosis

A

boston, milwaukee, charleston bending braces

Surger indicated if 45 degrees

70
Q

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

A

Septic hip

71
Q

Age 3-8 y/o, male

afebrile, well appearing

pain worse in am, improves during day

hx of recent uri

A

transient synovitis

72
Q

Kocher criteria

A
  1. wbc > 12k
  2. ESR > 40
  3. Fever > 101.3
  4. nwb on affected side

2/4 warrants joint aspiration for septic hip

73
Q

Imaging for septic hip

A

X-Ray: AP, frog-leg and lateral pelvic

Ultrasound: effusion and aspiration

MRI

74
Q

management of septic hip

A

EMERGENT

Surgical I & D, joint aspiration is diagnostic

Abx: Cephalosporins

If n. gonorrhoeae, high dose penicillin

75
Q

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
A

Perthes

76
Q

Imaging for Perthes

A

X-Ray: AP and frog laterals

Bone scan/MRI

77
Q

Tx of perthes

A

younger age = better outcome

control of sxs and hip preservation

78
Q
  • Male pt, between 10-16 y/o
  • Obese, limp or nwb w/ hip or knee pain
  • Restricted ROM, abduction and internal rotation
A

Slipped Capital Femoral Epiphysis (SCFE)

“Ice cream slipping off the cone”

79
Q

Diagnostics for SCFE

A

X-Ray: AP Pelvis and Frog Lateral

MRI if suspected but neg x-rays

80
Q

Tx of SCFE

A

urgent surgical consult

if NWB, admit to hospital

81
Q

Female, 1st born, breach pt.

presents w/ laxity, subluxation and dislocation of hip

+ barlow and ortolani w/ clunking sensation

+galeazzi

A

developmental dysplasia of the hip

82
Q

Management of DDH

A

Pavlik harness via ortho clinic

avoid swaddling and tight fitting clothes

monitor

X-Ray after 6-7 mo

83
Q

Fixed deformity.

midfoot = cavus
forefoot = adducts
hindfoot = varus
hindfoot = equinus

fhx, maternal smoking

A

clubfoot, congenital talipes equinovarus

84
Q

Tx of clubfoot

A

ponseti casting

Clinical Medicine I (25 decks)

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