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PCM IV Exam II > Peds pathology (Phumiruk) > Flashcards

Peds pathology (Phumiruk) Flashcards

1
Q

Erythema toxicum

A

Common rash-first few days after birth

  • Small blotchy erythematous areas with a raised yellow/white center

May be anywhere, including palms and soles, esp. on trunk

  • Usually in first week to ten days of life; up to 4 weeks

Dissipate without treatment in 5-7 days

Cause is unknown

  • Harmless
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2
Q

Milia

A

40% of newborns
Most often on the nose and cheek
Benign blocked skin pores & disappear by 1-2 months of age

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3
Q

Miliaria

A

“heat rash”

2 common forms
Miliaria crystallina
Small clear fluid filled vesicles that rupture and leave scale
Miliaria rubra
Clear fluid filled vesicles that are surrounded by red areas
Usually found on head, neck, trunk and in skin folds
* Blocked sweat gland ducts
Resolves on its own
Reoccurs w/ increased heat/humidity/bundling in warm clothing

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4
Q

Neonatal acne

A

> 30% of newborns

Begins at 3-4 weeks of age & lasts to 4-6 months of age

Cause is maternal androgens prior to birth

No treatment needed

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5
Q

Seborrheic dermatitis

A

= cradle cap (aka baby dandruff)

Scaling of scalp or eyebrows
Treatment:
baby oil, Nizoral shampoo or cream, Selsun shampoo
Frequent hairwashing with baby shampoo, soft brush

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6
Q

Transient neonatal pustular melanosis

A

Present at birth

Cause unknown

Tiny 1-2mm pustules on face, neck, ext, palms & soles

Can have scale around them

No erythema or inflammation

Rupture in first few days of life & leave behind freckles which fade in 3 weeks to 3 months

No treatment needed

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7
Q

Diaper rashes

A

Irritant diaper dermatitis
Reddish area in groin from urine or heat
* Treatment: barrier ointment (zinc oxide), air dry, frequent changes

Moniliasis (monilial diaper dermatitis)
Classically described as * “beefy red with satellite lesions”
Nystatin ointment

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8
Q

Mongolian spots

A

Blue-gray flat birthmark that is most often found in dark skinned infants

Entrapment of melanocytes in dermis during migration from neural crest cells into the epidermis

Usually over the back and buttocks but can be anywhere

Big variation in size

Most fade by 2-3 years of age; they may persist into adulthood

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9
Q

Atopic Dermatitis (eczema)

A

“the itch that rashes”

3-5% of children 6 mo to 10 yr

Ill-defined, red, pruritic, papules/plaques

  • Diaper area spared

Acute: * erythema, scaly, vesicles, crusts

Chronic: scaly, lichenified, pigment changes

Cause: unknown; ? Combination of dry, irritated skin w/ malfunction of immune system; ?genetic basis ?food causes flare

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10
Q

treatment for atopic dermatitis

A

TREAT WITH TOPICAL STEROIDS!

Antihistamines for itching
After showers, moisturize with thick ointments QUICKLY afterwards, don’t wipe completely dry
Vaseline, Aquaphor, Cetaphil, Eucerin, Vanicream
Dove unscented soap

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11
Q

Alopecia areata vs tinea capitis

A

Alopecia areata may have associated nail changes
R/o hypothyroidism
No broken hairs

Tinea capitis: black dots or gray patches
bad case- Kerion: inflammatory reaction

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12
Q

Acne

A 
Common condition characterized by the * blockage and inflammation of the pilosebaceous units of the face & trunk
and activity of Propionibacterium acnes
Black heads (open comedones)
White heads (closed comedones)
Pustular/cystic/nodules

Treatment: unplug the follicles and kill the bacteria!
- Hygeine: clean with antibacterial soap and water – facial products should be noncomedogenic and oil-free

  • Keratolytic:
    benzoyl peroxide based solutions, Tretinoin (a vitamin A derivative) also useful
  • Topical or oral antibiotic
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13
Q

Molluscum contagiosum

A

Viral
Usually no treatment recommended when less than 50 lesions or not on face
Pearly pink dome-shaped papules with central umbilication

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14
Q

Verruca Vulgaris

A

Pare, pare, pare!
Benign neglect (may go away in 2 yrs)
Salicylic acid topically
Cryotherapy

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15
Q

HSP (Henoch-Schonlein Purpura)

A

= “anaphylactoid purpura” characterized by 2-10mm erythematous hemorrhagic papules in a symmetric acral distribution, over the buttocks, and extremities –>* palpable purpura

Systemic vasculitis of small vessels of skin, GI tract, kidneys, joints
Abdominal pain, rash on legs, arthritis in ankles
* Urinalysis, which may be positive for blood or protein in 50% of the patients (other labs usually normal)

DDx: drug reactions, erythema multiforme, urticaria, and even physical abuse, other causes of purpura such as bleeding disorders, and/or infection (meningococcemia)

  • Renal involvement is the most frequent and serious complication, usually acute glomerulonephritis. Hypertension is uncommon.

Usually managed as outpatients. Severe abdominal pain, gastrointestinal hemorrhage, intussusception, and severe renal involvement are indications for admission.

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16
Q

Common benign murmurs - Infants

A

Closing ductus

  • Newborn
  • Transient, soft, ejection
  • Location: upper left sternal border

Peripheral pulmonary flow murmur
(= PPBS or peripheral pulmonic
branch stenosis)
- Newborn to 1 year
- Soft, slightly ejectile, systolic
- Location: to the left of upper left sternal border & in lung fields & axillae upper left sternal border.
- High pitched - best heard with the diaphragm
- Also seen in adolescents or in children with pectus excavatum.

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17
Q

how do benign murmers sound?

A

Low pitched (non-turbulent, not high velocity)

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18
Q

Common benign murmurs in Older child

A
  • Still’s
  • Low-pitched sounds heard at the lower left sternal area, * “musical.”
  • Most commonly between age 3 and adolescence
    Best heard with the bell of the stethoscope.
  • Changes with alteration of position and then can decrease or disappear with the Valsalva maneuver.
    No clicks are present.

Venous hum:

  • Low-pitched continuous murmurs made by blood returning from the great veins to the heart
  • Listen with bell
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19
Q

Ductus Arteriosus Closure

A

Premature infants - closure up to 2 years
Full term infants - closure rarely after first week of life w/o intervention

Indomethacin or surgery

20
Q

Patent Ductus Arteriosus

A

Failure of closure of ductus arteriosus within a few days after birth
Girls>boys
More common in premature infants, neonatal respiratory distress, infants w/ genetic d/o (such as Down syndrome) & those w/ congenital heart lesions
Small PDAs usu. asymptomatic

21
Q

Large PDAs:

**

A 
Bounding pulse, “machine-like” murmur
Tachypnea
Poor feeding habits
Shortness of breath
Sweating while feeding
Tiring very easily
Poor growth
22
Q

Hypertrophic Cardiomyopathy

A

Asymmetrical thickening of left ventricle
Causing increase work on heart to pump

Inherited

Younger people are likely to have a more severe form

Sx:
Chest pain
Dizziness
Fainting, especially during exercise
Heart failure (in some patients)
High blood pressure
Light-headedness, especially with or after activity or exercise
Palpitations
Shortness of breath
  • Sudden collapse/death occurs due to arrhythmia or blockage of blood flow
23
Q

Cyanotic Congenital Heart Disease

A 
5 T’s:   
Tetralogy of Fallot (like an “aortic takeover”)
		1. VSD
		2. Overriding aorta
		3. RV outflow obstruction
		4. RV hypertrophy

Transposition of the Great Arteries

TAPVR

Truncus arteriosus

Tricuspid Atresia

24
Q

Neonatal Respiratory Distress Syndrome

A 
Sx: (seen within minutes to a few hours after birth)
- Cyanosis
- Apnea
- Decreased urine output
- Grunting, nasal flaring
- Puffy or swollen arms or legs
- Rapid breathing &/or shortness of breath
CXR: * ground glass appearance
Tx: * surfactant, intubation or CPAP
  • Most common complication seen in premature infants that affects breathing
  • Due to lack of surfactant
  • Most cases seen in premies under 28 weeks
  • Increased risks of RDS:
    A brother or sister who had RDS
    Diabetes in the mother
    Cesarean delivery
    Delivery complications that lead to acidosis in the newborn at birth
    Multiple pregnancy (twins or more)
    Rapid labor
25
Q

Upper Respiratory Infections (Colds)

A

Acute, self-limiting viral syndrome of the upper respiratory tract

Children younger than six years have an average of * six to eight colds per year (up to one per month, September through April), with a typical symptom duration of 14 days

Young children in * daycare appear to have more colds than children cared for at home. However, when they enter primary school, children who attended daycare are less vulnerable to colds than those who did not.

Older children and adults have an average of two to four colds per year, with a typical symptom duration of five to seven days

Symptoms: rhinorrhea, congestion, sneezing, and may include fever

26
Q

Acute Otitis Media

A

Fever, otalgia, cough, rhinorrhea

Symptoms may be nonspecific in infants (feeding difficulties, irritability)

Older children have more classic presentation

May be a complication of URI

Tympanic membrane shows evidence of acute inflammation
Pathogens:
Viral
Bacterial top three organisms:
* Strep pneumoniae,
* Moraxella catarrhalis
* H. flu nontypables
Treatment:
First line: * amoxicillin (high dose = 80-90 mg/kg/day)
Second line: amoxicillin-clavulinic acid (Augmentin)
or second generation cephalosporin

27
Q

Sinusitis

A

Diagnosis is based on:

1. Persistence of nasal discharge: if the child has a very congested and/or runny nose for 10 days without improvement, especially when it is associated with a daytime  cough (may also have a night cough) 2. Severe symptoms: if the child has a high fever (over 39 C, which is 102.2 F) for 72 hours or has a high fever and is not eating or drinking and is difficult to calm 3. Worsening symptoms: a child's cold got better and then in a day or two the child is suddenly much more ill with a fever and/or pus-filled nasal discharge
28
Q

Croup

A

= laryngotracheobronchitis

  • Steeple sign (if you get an xray)
    *** Subglottic narrowing of trachea
    Most common cause of inspiratory *stridor in peds
    Viral in origin
    Most commonly parainfluenza
    Sx:
    Coryza 1-2d prior to * croupy cough, hoarseness, & stridor
    Tx: if severe, inhaled racemic epinephrine & oral steroids
29
Q

Bacterial tracheitis

A

Invasive exudative bacterial infection of the soft tissues of the trachea
= Acute bacterial laryngotracheobronchitis – similar to croup but worse
Pathogens:
- Staphylococcus aureus,
- Streptococcus pneumoniae
- Gram-negative enteric bacteria
- Pseudomonas aeruginosa

Predisposing viral infections with: * influenza A, influenza B, respiratory syncytial virus (RSV), parainfluenza virus, measles, and enterovirus

30
Q

Acute Pharyngitis- Viral

A

CMV
Adenoviruses
HSV
Influenza viruses
Enterovirus
EBV
- Monospot testing is not accurate under 4-5 years of age or before 2nd week of illness
- Really long incubation period (4-6 wks)
- Exudative pharyngitis is accompanied by fever, generalized adenopathy, hepatosplenomegaly, heterophile antibodies
– Sometimes treated with steroids in complicated cases
Supportive care

31
Q

Acute Pharyngitis- Bacterial

A

Group A beta hemolytic streptococcus

  • 15 to 30 percent of all cases of pharyngitis in children between the ages of 5 and 15 years
  • Peaks during the winter and early spring
  • Rapid strep in office, back up culture

Other bacterial pathogens

  • Group C and group G strep: acute rheumatic fever is not a complication of infection due to these organisms
  • Arcanobacterium hemolyticum
  • Corynebacterium diphtheriae
  • Tularemia
32
Q

Strep pharyngitis

A

History:
- Typically has an abrupt onset of symptoms
- Typically the school aged child
* Sore throat
* Fever
* Headache
* GI symptoms: abdominal pain, nausea, and vomiting
Poor oral intake
** NO cough or rhinorrhea!! Aka, no viral symptoms ( coryza, conjunctivitis, hoarseness, anterior stomatitis, discrete ulcerative lesions or vesicles).
Younger children may present with fever, abdominal pain, vomiting

Physical:
* Exudative pharyngitis or erythema of posterior orophayngeal mucosa
- Enlarged tender * anterior cervical lymph nodes
Palatal * petechiae
Inflamed uvula
* Scarlatiniform rash
* Pastia’s lines

Work Up:
* Rapid strep with back up culture if negative
How can you possibly get a sample??
Use two swabs at once; double tongue depressor for stronger kids, have smaller child pant like a puppy dog
Wear a mask because you’ll probably get coughed on

33
Q

Deep neck infections-

Peritonsillar abscess

A
  • Most common deep neck infection in children and adolescents, accounting for at least 50 percent of cases – can be a complication of strep pharyngitis
    Symptoms:
    Severe sore throat (usually unilateral)
    Fever
  • “Hot potato” or muffled voice
    Pooling of saliva or drooling may be present
  • Trismus
    Neck swelling and pain
  • Asymmetric tonsils on exam
    Treatment: needle aspiration: antimicrobial therapy (amoxicillin/clavulinic, cephalosporins, and clindamycin), and supportive care (hydration, analgesia)
34
Q

Deep neck infections- Retropharyngeal abscess

A

Most commonly in * young children between the ages of two and four years
Symptoms:
Difficulty swallowing (dysphagia)
pain with swallowing (odynophagia)
drooling with decreased oral intake
Unwillingness to move the neck secondary to pain (torticollis), particularly unwillingness to extend the neck
* “hot potato” quality [dysphonia]
Gurgling sound, or stertor (snoring sound)
Respiratory distress (stridor, tachypnea, or both); * stridor develops as disease progresses
Neck swelling, mass, or lymphadenopathy
* Trismus (in approximately 20 percent)

35
Q

Respiratory syncytial virus (RSV)

A

Respiratory virus affecting nasal passages and lungs
Almost all children will be infected by 2 years of age
Recovery within 1-2 weeks of infection

May be severe in premature or very young infants
- Risk factors for severe disease:
young age
— preterm birth (specific guidelines for immunization with Synagis = palivizumab)
- low birth weight
- chronic pulmonary disease
- cyanotic or complicated cardiac disease
- neurologic disease
- immunodeficiency or immunosuppression
congenital defects of the airway

Newborns with bronchiolitis may present with apnea

  • RSV is the most common cause of bronchiolitis
  • -> Inflammation of small airways of lung
Other causes of bronchiolitis include: 
* rhinovirus 
* parainfluenza
* influenza
* human metapneumovirus
* adenovirus
Seen most often in fall, winter & early spring
36
Q

Foreign body

A
  • Important cause of chronic cough in toddler

Nasal

  • Unilateral purulent drainage
  • Foul smelling

Lower respiratory tract

  • DDx: recurrent viral infections and asthma
  • PE and CXR may be unrevealing
37
Q

Gastroesophageal Reflux (GER)

A

Often begins in infancy

Signs/symptoms:

  • Vomiting
  • Poor weight gain
  • Substernal CP
  • Abdominal pain
  • Dysphagia
  • Esophagitis
  • Diagnosis often based on clinical presentation

Tests:

  • Upper GI (r/o other abnormalities)
  • 24 hr esophageal pH probe

Treatment:

  • Smaller feedings more frequently, positioning post feeds
  • Acid suppressive meds
  • OMT
38
Q

Viral Gastroenteritis

A

Rotavirus
- Most common cause of diarrhea in young children throughout the world
- Normally self-limiting but can cause severe dehydration
- Sx: fever, vomiting, diarrhea
- Highly contagious, lasting 3-9 days
Fecal-oral spread

Vaccination in early infancy
Rotateq 3 dose series
Rotarix 2 dose series

39
Q

Esophageal foreign bodies

A

in the esophagus- coin lays flat
in the trachea on its side

Urgent or emergent intervention:

When the object is sharp, long, or consists of magnets
When the object is a * disk battery in the esophagus
If * airway compromise, such as tracheal compression, is present
If there is evidence of esophageal obstruction (eg, the patient is unable to swallow secretions)
If there are signs or symptoms suggesting inflammation or intestinal obstruction (fever, abdominal pain, or vomiting)
If the object is in the esophagus and the suspected ingestion occurred 24 or more hours prior to the evaluation, or if the time of ingestion is unknown

40
Q

Buried penis

A

Neonates
Result of thick suprapubic fat
Resolve as infant grows

41
Q

Hypospadius

A

1:250 male births

Infants should not be circumcised
- Dorsal preputial skin may be needed for repair

Repair usu. at 6 months of age

42
Q

Labial adhesions

A

Common in prepubertal age group

Fusion of labia minora

?inflammation of thin labial mucosa that adheres in midline

Severe fusion may result in dysuria& urinary problems including UTIs

  • Tx: mechanical separation then petroleum ointment to diminish irritation
  • estrogen creams (Premarin)
43
Q

Vesicoureteral reflux (VUR)

A

Congenital
Normal valve mechanics of ureterovesicular junction is impaired
Reflux from bladder to ureter or kidney
Grades I –> III high rate of spontaneous resolution
Suppressive prophylactic antibiotics

44
Q

UTI

A

Girls>boys

  • Don’t trust a culture from a bag urine sample!!

Catheterized sample only in infants

  • Infants may present with vomiting only

Clean catch if potty trained

45
Q

Febrile seizure

A

3-5% of healthy toddlers will have seizure caused by fever (9m-5 yrs)
Tends to run in families
- Likely to have more than one febrile seizure if:
- There is a family history of febrile seizures
- The first seizure happened before age 12 months
- The seizure occurred with a fever below 102oF

46
Q

Types of febrile seizures

A
  • Simple febrile seizure
  • Lasts a few seconds to 5-10 minutes
  • Generalized
    Followed by a period of drowsiness or confusion (30 minutes post-ictal)
  • Complex febrile seizure
  • Lasts longer than 15 minutes
  • Focal - in just one part of the body
  • Occurs again during the same illness
47
Q

Duchene’s Muscular Dystrophy

A

Progressive degeneration of skeletal muscle
1:3500 male births
X-linked recessive
Early onset, symmetrical, begins w/ pelvic/pectoral girdle involvement
Confined to wheelchair by adolescence
Death from cardioresp. Insufficiency by age 20
* Gower maneuver

PCM IV Exam II (8 decks)

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