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clin med IV > peds random > Flashcards

peds random Flashcards

1
Q

strabismus

A
  • anomoly of ocular alignment
  • unilat or bilat
  • can be normal variant in newborns
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2
Q

esotropia

A
  • nasal deviation
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3
Q

exotropia

A
  • temporal deviation
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4
Q

latent strabismus

A
  • “-phoria”

- present when fixation is interrupted

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5
Q

manifest strabisums

A
  • “-tropia”
  • present without interruption of gaze
  • can be intermittent or constant
  • monocular or alternating
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6
Q

hering’s law

A
  • two eye law

- agonist muscles in both eye have equal innervation

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7
Q

sherringon’s law

A
  • one ey law

- agonist/ antagonist pairs in each eye receive reciprocal innervation`

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8
Q

risk factors for primary strabismus

A
  • family hx
  • low birth weight
  • muscular abnormality
  • visual deprivation
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9
Q

dx of strabismus

A
  • complete hx
  • corneal light reflex/ hirschberg
  • cover, cover/ uncover
  • bruckner red reflex
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10
Q

amblyopia

A
  • “lazy eye”

- complication of strabismus

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11
Q

complications of strabismus

A
  • amblyopia
  • diplopia- acquired stabismus in kids > 3
  • contracture of extraocular muscles
  • psychosocial and vocational consequences
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12
Q

tx of strabismus

A
  • prescription glasses +/- prism
  • miotic drops
  • patching
  • visual training exs
  • surgical repositioning or shortening
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13
Q

impetigo

A
  • contagious bacterial infection
  • can be primary or secondary
  • usu in kids 2-5 y/o
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14
Q

common cause of impetigo

A
  • staph aureus
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15
Q

risk factors for impetigo

A
  • poverty
  • crowding
  • poor hygiene
  • scabies
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16
Q

types of impetigo

A
  • non-bullous: most common
  • bullous
  • ecthyma
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17
Q

clinical manifestatoins of non-bullous impetigo

A
  • papules- vesicles surrounded by erythema and pustules
  • golden honey colored crust
  • usu on face and extremities
  • +/- regional LAD
  • NO systemic sx
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18
Q

clinical manifestaitons of bullous impetigo

A
  • “more severe” non- bullous
  • bullae filled with clear yellow fluid
  • rupture to form thin brown curst
  • fewer lesions
  • usu in younger kids
  • common on trunk
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19
Q

clinical manifestations of ecthyma impetigo

A
  • ulcerative punched out lesions
  • yellow crust, raised margins
  • lesions into dermis
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20
Q

dx of impetigo

A
  • clinical
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21
Q

tx of impetigo

A
  • topical mupirocin or H2O2 cream
  • PO abx: diclox, cephalexin, clinda
  • bactrim if suspect MRSA
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22
Q

pinworms

A
  • d/t enterobius cermicularis
  • < 1 cm white and threadlike
  • inhibit cecum, appendix, ileum, ascending colon
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23
Q

eggs of pinworms

A
  • migrate to anal/ perianal area in PM to lay eggs
  • embryonate up to 20 days
  • form adult works in 36 to 53 days
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24
Q

how do pinworms spread

A
  • fecal oral route

- carried on fingernails, bedding, dust, clothing

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25
Q

clinical manifestations of pinworms

A
  • nocturnal/ AM perianal and perineal itching

- visible worms around anus and on buttocks

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26
Q

dx of pinworms

A
  • hx of nocturnal itching
  • collection with cellophane tape or pinworm paddle
  • visual inspection
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27
Q

treatment of pinworms

A
  • albendazole 400 mg, repeat in 2 weeks
  • treat family members
  • good hygiene: bath in early AM, wash clothes and linens, hand washing
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28
Q

measles si/sx

A
  • fever
  • cough, coryza, conjunctivitis
  • koplik spots*
  • then maculopapular rash head to toe 14 days after exposure
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29
Q

when is the measles rash contagious

A
  • 4 days before through 4 days after rash
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30
Q

what causes measles

A
  • RNA virus morbillivirus
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31
Q

complications of measles

A
  • OM
  • pneumonia, bronchpneumonia
  • croup
  • diarrhea
  • acute encephalitis -> permanent damage
  • die from respiratory or neuro complications
  • subacute sclerosing panencephalitis 7-10 yrs later -> fatal
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32
Q

transmission of measles

A
  • highly contagious
  • direct contact with droplets or airborne
  • can remain on surfaces for up to 2 hours
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33
Q

testing for measles

A
  • serum or NP swab
  • measles IgM ab, RNA PCR
  • can collect urine
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34
Q

post exposure ppx for measles

A
  • MMR vaccine within 72 hours
  • OR
  • IG if admin within 6 days of exposure
  • may provide protection or modify course of disease
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35
Q

treatment of measles

A
  • severe causes give vit A immed then repeat next day
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36
Q

what does vit A deficiency cause in measles

A
  • delayed recovery
  • high rate of complications
  • xeropthalmia
  • preventable childhood blindness (esp in Africa)
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37
Q

Fifth disease

A
  • aka erythema infectiuosum
  • d/t parvovirus B19
  • incubation pd of 1-2 weeks prior to sx
38
Q

transmission of fifth disease

A
  • unknown transmission method
  • high transmission rates in households
  • transmisison stops after rash develops
39
Q

clinical manifestations of fifth disease

A
  • days 1-2: HA, fever, N/D
  • days 2-5: rash
  • rash may appear with sunlight, head, exercise, stress
  • sx may linger/ wax and wane for weeks
40
Q

rash of fifth disease

A
  • slapped cheeks
  • circumoral pallor
  • reticulated/ lacy rash on trunk and extremities
41
Q

treatment for fifth disease

A
  • supportive

- NO pharm tx

42
Q

complications of fifth disease

A
  • transient aplastic crisis
  • fetal hydrops- fetal demise if mom is pregnant
  • arthritis/ arthralgia
  • chronic sx
43
Q

other names for infectious mononucleosis

A
  • mono
  • kissing disease
  • EBV
  • epstein barr
44
Q

cause of mono

A
  • EBV - widely disseminated herpesvirus

- 95% of all aduts are seropositive for EBV

45
Q

transmission of mono

A
  • virus shed in salivary secretions
  • found but not transitted in breast milk
  • found in cervical epithelial cells and semen- ? sexual transmission
46
Q

what is the incubation pd of mono

A
  • 4-7 weeks
47
Q

clinical manifestations of mono

A
  • fever in 98%
  • pharyngitis with exudates and petechiae
  • posterior chain LAD
  • fatigue
  • atypical lymphocytosis early
  • splenomegaly
  • rash
  • hepatitis- self limited
48
Q

rash of mono

A
  • maculopapular
  • urticarial
  • petechial
  • commonly seen post pcn. amp use
  • may be assoc with azithro, levoquin, or keflex
49
Q

less common manifestations of mono

A
  • GBS
  • CN palsies
  • aspetic meningitis
  • optic neuritis
  • transverse meylitis
  • cholestasis
  • pneumonia
  • myocarditis
  • pancreatitis
  • mesenteric adenitis
50
Q

dx of mono

A
  • mostly clinical
  • may see atypical lymphocytes on diff
  • heterophile ab= monospot, may be neg in first week
  • mono pannel
51
Q

what is included in the mono pannel

A
  • EBV IgM and IgG viral capsid antigens

- EBDNA

52
Q

treatment of mono

A
  • supportive care: antipyretics, hydration
  • steroids if airway compromise
  • NO indications for antivrial tx
  • splenic rupture precautions
  • rest during periods of fatigue, bed rest not necessary
53
Q

what are the splenic rupture precautions for mono

A
  • 2 weeks of mild activity
  • min 4 weeks for contact/ high risk sports
  • longer if spleen is enlarged by palpation or US
54
Q

rubella si/sx

A
  • rash + low grade fever
  • sx last 2-3 days
  • old kids/ adults may have LAD and arthrlagias
55
Q

how is rubella transmitted

A
  • airborne

- is included in prenatal screen

56
Q

complications of rubella

A
  • birth defects in pregnant women:
  • deafness
  • cataracts
  • heart defects
  • developmental delay
  • liver and spleen damage
57
Q

what is another name for rubella

A
  • germen measles
58
Q

what causes roseola

A
  • HHV6 and HHV7

- can be transmitted vertically

59
Q

clinical manifestations of roseola

A
  • sudden fever 102-104
  • fever subsides then rash appears 24 hours later
  • rash is on trunk, arms, legs
  • morbilliform rash, asymptomatic
60
Q

what is kawasaki’s

A
  • type of vasculitis, most common childood vasculitis
  • widespread inflam of medium sized BV throughout entire body
  • affects vessels of the heart*
  • most visible affects mucous membranes
61
Q

what vessels are impacted long term from kawasaki’s

A
  • coronary arteries
62
Q

who typically gets kawasaki’s

A
  • < 5 y/o
  • more commonly boys
  • increased risk in asian and pacific islanders
63
Q

pathophys of kawasaki’s

A
  • neutrophilic infiltrate in vessel walls

- edema of endothelial SMC of vessel walls

64
Q

clinical manifestations of kawasaki’s

A
  • fever 5+ days > 100.5
  • bilat bulbar conjunctivitis
  • mucositis
  • rash
  • edema and erythema of hands or feet
  • desquamation
  • cervical LAD
  • CV findings
  • arthritis in large joints
65
Q

rash of kawasaki’s

A
  • erythema
  • desquamation
  • polymorphous: macular, morbilliorm, targetoid
  • NOT vescicular or bullous
66
Q

where does desquamation occur in kawasaki’s

A
  • periungual
  • perineal
  • sheet like losses
67
Q

mucositis of kawasaki’s

A
  • fissured lips
  • injected pharynx
  • strawberry tongue
68
Q

diagnosis of kawasaki’s

A
  • clinical*
  • +/- elevated ESR, CRP, plt
  • normochromic/ cytic anemia
  • +/- elevated transaminases
  • UA: WBC without infection
  • each pt needs echo**
69
Q

treatment for kawasaki’s

A
  • admit all pts
  • monitor CV fn
  • once fever resolved risk of HF or heart dysfunction is low
  • IVIG
  • ASA
  • steroids or INF inhibitors if IVIG fails twice
70
Q

IVIG administration for kawasaki’s

A
  • dramatically decreases risk of coronary artery aneurysm
  • given within 7-10 d of illness
  • ideally given within 5-7 days
  • fever should drop after 36 hours
  • if fever does not drop then repeat dose once
71
Q

ASA administration in kawasaki’s

A
  • 80-100 mg/kg for first 14 days
  • then daily at 3-5 mg/kg for 6-8 weeks
  • used for anti-inflam and anti-plt effects
72
Q

possible CV findings in kawasaki’s

A
  • tachycardia out of proportion to fever
  • muffled heart sounds
  • brachial aneurysms
  • cold pale cyanotic digits
  • coronary artery aneurysm*
  • myocarditis
  • pericarditis
  • MI
  • arrhythmias
73
Q

follow up for kawasaki’s

A
  • cardiology consult at dx*
  • f/u echo 3-4 weeks after fever
  • if no aneurysm then next echo 12 mo post illness, risk assessment q 5 yrs
  • physical activity limited for 3 mo if no aneurysm
  • no live virus vaccines for 11 mo if IVIG
  • flu vaccine- esp those getting ASA
74
Q

coronary complications of kawasaki’s

A
  • HF
  • ischemia or infarction
  • arrhythmias
  • arterial thrombosis
75
Q

prognosis of kawasaki’s

A
  • morbidity rate low when dx and treated early
  • low morbidity if no CA disease
  • high concern for complications if CA disease with dilation > 8 mm
76
Q

what is another name for coxsackie

A
  • hand, foot, mouth
77
Q

what causes coxsackie and how is it transmitted

A
  • enterovirus
  • fecal oral transmission
  • risk of spread to close contacts
78
Q

presentation of coxsackie

A
  • apthous stomatitis*- in back of mouth
  • rash on hands and feet
  • fever
  • possible aseptic meningitis
79
Q

diagnosis of coxsackie

A
  • clinical
80
Q

treatment of coxsackie

A
  • symptomatic
  • tylenol or motrin
  • magic mouthwash: benadryl + maalox, add viscous lido if > 2
  • correct dehydration
81
Q

what is the varicella vaccine

A
  • varivax
  • can get attenuated illness since it is a live vaccine
  • need bosters
82
Q

what does varicella look like

A
  • dew drop on rose petal appearance
83
Q

treatment for varicella

A
  • symptomatic
  • motrin or tylenol for fever
  • benadryl, aveeno for itch
  • if high risk consider antivirals
84
Q

rare complications of varicella

A
  • encephalitis
  • pneumonia
  • bronchitis
  • post herpetic neuralgia rare in kids
85
Q

where does varicella live dormant

A
  • dorsal root gangia

- trigeminal nerve

86
Q

what is enuresis

A
  • involuntary urination

- nocturnal= bed wetting

87
Q

treatment for enuresis

A
  • DDAVP to increase ADH
  • moisture alarms
  • scheduled voiding
  • decreased bladder stimulants like caffeine
  • limit fluid intake before bed
88
Q

UTI in infants

A
  • anatomical abnormality: vesicoureteric reflex
  • think UTI if URI sx + fever and < 3 mo
  • need cath specimen
  • treat and then work up if first in male or female
89
Q

UTI in children

A
  • toilet training, poor wiping
  • constipation, withholding
  • abd pain, maybe dysuria and freqency
  • clean catch specimen once toilet trained
  • treat and work up first in male, second in female
90
Q

UTI in teens

A
  • STI or sexually transmitted until proven it is not
  • e coli, proteus
  • urinate after intercourse if female

clin med IV (23 decks)

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