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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
clinical manifestations of pinworms
- nocturnal/ AM perianal and perineal itching | - visible worms around anus and on buttocks
26
dx of pinworms
- hx of nocturnal itching - collection with cellophane tape or pinworm paddle - visual inspection
27
treatment of pinworms
- albendazole 400 mg, repeat in 2 weeks - treat family members - good hygiene: bath in early AM, wash clothes and linens, hand washing
28
measles si/sx
- fever - cough, coryza, conjunctivitis - koplik spots* - then maculopapular rash head to toe 14 days after exposure
29
when is the measles rash contagious
- 4 days before through 4 days after rash
30
what causes measles
- RNA virus morbillivirus
31
complications of measles
- OM - pneumonia, bronchpneumonia - croup - diarrhea - acute encephalitis -> permanent damage - die from respiratory or neuro complications - subacute sclerosing panencephalitis 7-10 yrs later -> fatal
32
transmission of measles
- highly contagious - direct contact with droplets or airborne - can remain on surfaces for up to 2 hours
33
testing for measles
- serum or NP swab - measles IgM ab, RNA PCR - can collect urine
34
post exposure ppx for measles
- MMR vaccine within 72 hours - OR - IG if admin within 6 days of exposure - may provide protection or modify course of disease
35
treatment of measles
- severe causes give vit A immed then repeat next day
36
what does vit A deficiency cause in measles
- delayed recovery - high rate of complications - xeropthalmia - preventable childhood blindness (esp in Africa)
37
Fifth disease
- aka erythema infectiuosum - d/t parvovirus B19 - incubation pd of 1-2 weeks prior to sx
38
transmission of fifth disease
- unknown transmission method - high transmission rates in households - transmisison stops after rash develops
39
clinical manifestations of fifth disease
- 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
rash of fifth disease
- slapped cheeks - circumoral pallor - reticulated/ lacy rash on trunk and extremities
41
treatment for fifth disease
- supportive | - NO pharm tx
42
complications of fifth disease
- transient aplastic crisis - fetal hydrops- fetal demise if mom is pregnant - arthritis/ arthralgia - chronic sx
43
other names for infectious mononucleosis
- mono - kissing disease - EBV - epstein barr
44
cause of mono
- EBV - widely disseminated herpesvirus | - 95% of all aduts are seropositive for EBV
45
transmission of mono
- virus shed in salivary secretions - found but not transitted in breast milk - found in cervical epithelial cells and semen- ? sexual transmission
46
what is the incubation pd of mono
- 4-7 weeks
47
clinical manifestations of mono
- fever in 98% - pharyngitis with exudates and petechiae - posterior chain LAD - fatigue - atypical lymphocytosis early - splenomegaly - rash - hepatitis- self limited
48
rash of mono
- maculopapular - urticarial - petechial - commonly seen post pcn. amp use - may be assoc with azithro, levoquin, or keflex
49
less common manifestations of mono
- GBS - CN palsies - aspetic meningitis - optic neuritis - transverse meylitis - cholestasis - pneumonia - myocarditis - pancreatitis - mesenteric adenitis
50
dx of mono
- mostly clinical - may see atypical lymphocytes on diff - heterophile ab= monospot, may be neg in first week - mono pannel
51
what is included in the mono pannel
- EBV IgM and IgG viral capsid antigens | - EBDNA
52
treatment of mono
- 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
what are the splenic rupture precautions for mono
- 2 weeks of mild activity - min 4 weeks for contact/ high risk sports - longer if spleen is enlarged by palpation or US
54
rubella si/sx
- rash + low grade fever - sx last 2-3 days - old kids/ adults may have LAD and arthrlagias
55
how is rubella transmitted
- airborne | - is included in prenatal screen
56
complications of rubella
- birth defects in pregnant women: - deafness - cataracts - heart defects - developmental delay - liver and spleen damage
57
what is another name for rubella
- germen measles
58
what causes roseola
- HHV6 and HHV7 | - can be transmitted vertically
59
clinical manifestations of roseola
- sudden fever 102-104 - fever subsides then rash appears 24 hours later - rash is on trunk, arms, legs - morbilliform rash, asymptomatic
60
what is kawasaki's
- 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
what vessels are impacted long term from kawasaki's
- coronary arteries
62
who typically gets kawasaki's
- < 5 y/o - more commonly boys - increased risk in asian and pacific islanders
63
pathophys of kawasaki's
- neutrophilic infiltrate in vessel walls | - edema of endothelial SMC of vessel walls
64
clinical manifestations of kawasaki's
- 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
rash of kawasaki's
- erythema - desquamation - polymorphous: macular, morbilliorm, targetoid - NOT vescicular or bullous
66
where does desquamation occur in kawasaki's
- periungual - perineal - sheet like losses
67
mucositis of kawasaki's
- fissured lips - injected pharynx - strawberry tongue
68
diagnosis of kawasaki's
- clinical* - +/- elevated ESR, CRP, plt - normochromic/ cytic anemia - +/- elevated transaminases - UA: WBC without infection - each pt needs echo**
69
treatment for kawasaki's
- 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
IVIG administration for kawasaki's
- 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
ASA administration in kawasaki's
- 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
possible CV findings in kawasaki's
- tachycardia out of proportion to fever - muffled heart sounds - brachial aneurysms - cold pale cyanotic digits - coronary artery aneurysm* - myocarditis - pericarditis - MI - arrhythmias
73
follow up for kawasaki's
- 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
coronary complications of kawasaki's
- HF - ischemia or infarction - arrhythmias - arterial thrombosis
75
prognosis of kawasaki's
- 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
what is another name for coxsackie
- hand, foot, mouth
77
what causes coxsackie and how is it transmitted
- enterovirus - fecal oral transmission - risk of spread to close contacts
78
presentation of coxsackie
- apthous stomatitis*- in back of mouth - rash on hands and feet - fever - possible aseptic meningitis
79
diagnosis of coxsackie
- clinical
80
treatment of coxsackie
- symptomatic - tylenol or motrin - magic mouthwash: benadryl + maalox, add viscous lido if > 2 - correct dehydration
81
what is the varicella vaccine
- varivax - can get attenuated illness since it is a live vaccine - need bosters
82
what does varicella look like
- dew drop on rose petal appearance
83
treatment for varicella
- symptomatic - motrin or tylenol for fever - benadryl, aveeno for itch - if high risk consider antivirals
84
rare complications of varicella
- encephalitis - pneumonia - bronchitis - post herpetic neuralgia rare in kids
85
where does varicella live dormant
- dorsal root gangia | - trigeminal nerve
86
what is enuresis
- involuntary urination | - nocturnal= bed wetting
87
treatment for enuresis
- DDAVP to increase ADH - moisture alarms - scheduled voiding - decreased bladder stimulants like caffeine - limit fluid intake before bed
88
UTI in infants
- 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
UTI in children
- 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
UTI in teens
- 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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