Peds Path Part 2 Flashcards
Developmental Hip Dysplasia
Displacement of femoral head from normal relationship w/ acetabulum - 1 or 2 in 1000 births - * F>M - Unilateral 2X as frequent as bilateral - Varying severities - Risk factors: In utero positioning * Breech presentation - PE: Ortolani/Barlow maneuvers - Imaging: Ultrasound ideally at six weeks, or Xray AP frog leg 4-6 months (ossification not begun till that time)
Findings in developmental hip dysplasia:
Femoral head lateral & superior to normal position
Acetabulum may be shallow
Physiologic genu varum
Bowlegged Seen in 1-3 yr olds Associated w/ laxity of other joints & internal tibial torsion Waddling gait or kick heels Tx: rarely indicated, resolves w/ growth
Physiologic genu valgum
Knock-kneed Seen in 3-5 yr olds F>M May be associated w/ ligamentous laxity R/o rickets/renal dz Tx: not generally indicated - Corrects w/ time
Nursemaid’s Elbow
Radial head subluxation
Supination-flexion technique
Hyperpronation/forced pronation technique
Slipped capital femoral epiphysis (SCFE)
SCFE occurs when the epiphysis slips off the end of the femur
Overweight 11-16 yo boys>girls; AA>whites
Pain in hip, thigh, groin, or knee
- Stable-can walk with or without crutches
- Leg maybe stiff, limp, or painful (comes & goes)
- – Leg may externally rotate or appear shorter
- Unstable-very painful; pt will not want to move leg
Diagnosed with x-ray
- Widened physis
- Step off (late sign)
Treatment is surgery (screw)
Complications include avascular necrosis and chondrolysis
Osgood-Schlatter disease
- Traction apophysitis of tibial tubercle
M>F
Cause:
- Differential rates of osseous & soft tissues
- Stress on apophyses by vigorous physical activity
Pain often relieved w/ rest
PE: tenderness/swelling
Duration: 6-24 months
Tx: rest, NSAIDS, cast/splint (if severe)
Steroid contraindicated
Septic arthritis and Osteomyelitis
“The sun must never rise nor set on a septic joint.”
Presenting symptoms: Fever, bone pain, swelling, redness, limp if ambulatory
Pathophysiology:
* Hematogenous spread to the synovium
* Rich vascular supply in their growing bones
Neonates and young children often have coexisting septic arthritis and osteomyelitis
Septic arthritis pathogens:
- Neonates: Staph aureus, E coli, GBS
- Older children: Staph aureus, MRSA
- – also: Neisseria, GAS, and Salmonella
Osteomyelitis pathogens:
- Staph aureus, Strep pyogenes, Strep pneumoniae
Septic arthritis and Osteomyelitis
“The sun must never rise nor set on a septic joint.”
Presenting symptoms: Fever, bone pain, swelling, redness, limp if ambulatory
Pathophysiology:
* Hematogenous spread to the synovium
* Rich vascular supply in their growing bones
Neonates and young children often have coexisting septic arthritis and osteomyelitis
Septic arthritis pathogens:
- Neonates: Staph aureus, E coli, GBS
- Older children: Staph aureus, MRSA
- – also: Neisseria, GAS, and Salmonella
Osteomyelitis pathogens:
- Staph aureus, Strep pyogenes, Strep pneumoniae
Impetigo
- Honey crusted lesions: red, crusting, dried pus or discharge, or oozing patches
- Staph infections, sometimes secondary to scratching of skin (itching from other etiologies)
Treatment: topical antibiotic cream, oral antibiotics for larger areas, keep clean with antibacterial soap and water
Hand-foot-mouth
- Coxsackie A 16
At risk: preschoolers
Highly contagious
Incubation: 4-6 days
Prodrome: 1-2 days before rash
Low grade fever, anorexia, malaise, sore throat
- Painful, shallow, yellow ulcers surrounded by red halos
- Found on buccal mucosa, tongue, soft palate, uvula and anterior tonsillar pillars
Exanthem involves * palmar, plantar and interdigital surfaces of the hands and feet +/- buttocks
Oral lesions without the exanthem = * herpangina
Erythema infectiosum
(5th disease)
* Parvovirus B19 At risk: school age children (4-10) Season: sporadic Incubation: 4-14 days Infectious: until the onset of the rash
Rash on face is characteristic “slapped cheek” appearance*
Lacy reticular rash on trunk
>50% asymptomatic
Prodrome
Mild fever (15-30%), sore throat, malaise
Dangerous for pregnant women in 1st trimester
Can cause severe anemia, hydrops fetalis
Roseola infantum
Aka Exanthem subitum Human Herpes Virus 6 (7) At risk 6-36 months (peak 6-7 months) Season: sporadic Incubation: 9 days Infectious: until onset of rash * High fever for 3-4 days * Abrupt drop in fever with appearance of rash Associated seizures likely due to infection of the meninges by the virus
Herpetic gingivostomatitis
Human Herpes Virus 1
Gingivostomatitis most common 1º infection in children
- Fever, irritability, cervical nodes
- Small yellow ulcerations with red halos on mucous membranes
Involvement more diffuse – easy to differentiate from herpangina and exudative tonsillitis
Treatment: supportive
Herpetic whitlow
Lesions on thumb usually 2° to autoinoculation
Group, thick-walled vesicles on erythematous base
Painful
Tend to coalesce, ulcerate and then crust
May require topical or oral acyclovir
Meningitis
Prodrome few hrs to 5 days
- URI, nasopharyngitis w/ fever
Abrupt change
- Vomiting
- Irritability (“inconsolable”)
- Nuchal rigidity – not reliable under 18 mos
- Bulging fontanelle
Meningococcemia
10% infants show overwhelming sepsis
- Little to no initial lab evidence of meningitis
See same abrupt change in clinical appearance
- In addition, rash in association w/ shock
85% show rash on trunk/extremities
- May progress to frank necrosis
- Death can occur in 24 hours of presentation
Rocky Mountain Spotted Fever
Acute, potentially severe
Exanthematous disease
Cause: Rickettsia rickettsii
- Obligate intracellular parasites
Transmitted by infected tick
Spring/summer
Incubation: 2-14 days
Sx: fever, HAs, anorexia, N/V/D, sore throat, myalgias
- Rash spread most distinguishing feature: * begins distally (erythematous, blanching, fine, maculopapular), spreads centripetally & becomes petechial
- Often see conjunctival erythema, edema and photophobia w/ rash
Test: for rickettsia (takes at least 1 wk)
Must treat immediately if suspected
- Doxycycline (in all children)
- If treat within first week prognosis is good
Measles
Maculopapular rash beginning on the face and spreading to the trunk and extremities
Often Koplik spots (white spots on buccal mucosa)
Fever, cough, coryza, conjunctival injection
Contact dermatitis
itchy erythema, sometimes with vesicles
No systemic manifestations
Kawasaki
Diffuse erythematous maculopapular rash
Must have fever (often > 39° C) for > 5 days
Red, cracked lips, strawberry tongue, conjunctivitis, cervical lymphadenopathy, swelling of hands/feet
Strep throat treatment
Amoxicillin 40mg/kg/day divided BID-TID (“low dose amox”) for 10 days OR Pen G (Benzathine PCN): <27 kg: 600,000U/dose IM X 1 >27 kg-adult: 1.2 million U/dose IM X 1
Recurrence of strep
Persistence of streptococcus carriage in the setting of viral infection
Nonadherence with the prescribed antimicrobial regimen
New infection with GAS acquired from household or community contacts
Treatment failure (eg, repeat episode of pharyngitis caused by the original infecting strain) is rare
For patients with as many as six GAS infections in a single year or three to four episodes in two consecutive years, tonsillectomy may be an appropriate therapeutic consideration
