peds random Flashcards
strabismus
- anomoly of ocular alignment
- unilat or bilat
- can be normal variant in newborns
esotropia
- nasal deviation
exotropia
- temporal deviation
latent strabismus
- “-phoria”
- present when fixation is interrupted
manifest strabisums
- “-tropia”
- present without interruption of gaze
- can be intermittent or constant
- monocular or alternating
hering’s law
- two eye law
- agonist muscles in both eye have equal innervation
sherringon’s law
- one ey law
- agonist/ antagonist pairs in each eye receive reciprocal innervation`
risk factors for primary strabismus
- family hx
- low birth weight
- muscular abnormality
- visual deprivation
dx of strabismus
- complete hx
- corneal light reflex/ hirschberg
- cover, cover/ uncover
- bruckner red reflex
amblyopia
- “lazy eye”
- complication of strabismus
complications of strabismus
- amblyopia
- diplopia- acquired stabismus in kids > 3
- contracture of extraocular muscles
- psychosocial and vocational consequences
tx of strabismus
- prescription glasses +/- prism
- miotic drops
- patching
- visual training exs
- surgical repositioning or shortening
impetigo
- contagious bacterial infection
- can be primary or secondary
- usu in kids 2-5 y/o
common cause of impetigo
- staph aureus
risk factors for impetigo
- poverty
- crowding
- poor hygiene
- scabies
types of impetigo
- non-bullous: most common
- bullous
- ecthyma
clinical manifestatoins of non-bullous impetigo
- papules- vesicles surrounded by erythema and pustules
- golden honey colored crust
- usu on face and extremities
- +/- regional LAD
- NO systemic sx
clinical manifestaitons of bullous impetigo
- “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
clinical manifestations of ecthyma impetigo
- ulcerative punched out lesions
- yellow crust, raised margins
- lesions into dermis
dx of impetigo
- clinical
tx of impetigo
- topical mupirocin or H2O2 cream
- PO abx: diclox, cephalexin, clinda
- bactrim if suspect MRSA
pinworms
- d/t enterobius cermicularis
- < 1 cm white and threadlike
- inhibit cecum, appendix, ileum, ascending colon
eggs of pinworms
- migrate to anal/ perianal area in PM to lay eggs
- embryonate up to 20 days
- form adult works in 36 to 53 days
how do pinworms spread
- fecal oral route
- carried on fingernails, bedding, dust, clothing
clinical manifestations of pinworms
- nocturnal/ AM perianal and perineal itching
- visible worms around anus and on buttocks
dx of pinworms
- hx of nocturnal itching
- collection with cellophane tape or pinworm paddle
- visual inspection
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
measles si/sx
- fever
- cough, coryza, conjunctivitis
- koplik spots*
- then maculopapular rash head to toe 14 days after exposure
when is the measles rash contagious
- 4 days before through 4 days after rash
what causes measles
- RNA virus morbillivirus
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
transmission of measles
- highly contagious
- direct contact with droplets or airborne
- can remain on surfaces for up to 2 hours
testing for measles
- serum or NP swab
- measles IgM ab, RNA PCR
- can collect urine
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
treatment of measles
- severe causes give vit A immed then repeat next day
what does vit A deficiency cause in measles
- delayed recovery
- high rate of complications
- xeropthalmia
- preventable childhood blindness (esp in Africa)
Fifth disease
- aka erythema infectiuosum
- d/t parvovirus B19
- incubation pd of 1-2 weeks prior to sx
transmission of fifth disease
- unknown transmission method
- high transmission rates in households
- transmisison stops after rash develops
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
rash of fifth disease
- slapped cheeks
- circumoral pallor
- reticulated/ lacy rash on trunk and extremities
treatment for fifth disease
- supportive
- NO pharm tx
complications of fifth disease
- transient aplastic crisis
- fetal hydrops- fetal demise if mom is pregnant
- arthritis/ arthralgia
- chronic sx
other names for infectious mononucleosis
- mono
- kissing disease
- EBV
- epstein barr
cause of mono
- EBV - widely disseminated herpesvirus
- 95% of all aduts are seropositive for EBV
transmission of mono
- virus shed in salivary secretions
- found but not transitted in breast milk
- found in cervical epithelial cells and semen- ? sexual transmission
what is the incubation pd of mono
- 4-7 weeks
clinical manifestations of mono
- fever in 98%
- pharyngitis with exudates and petechiae
- posterior chain LAD
- fatigue
- atypical lymphocytosis early
- splenomegaly
- rash
- hepatitis- self limited
rash of mono
- maculopapular
- urticarial
- petechial
- commonly seen post pcn. amp use
- may be assoc with azithro, levoquin, or keflex
less common manifestations of mono
- GBS
- CN palsies
- aspetic meningitis
- optic neuritis
- transverse meylitis
- cholestasis
- pneumonia
- myocarditis
- pancreatitis
- mesenteric adenitis
dx of mono
- mostly clinical
- may see atypical lymphocytes on diff
- heterophile ab= monospot, may be neg in first week
- mono pannel
what is included in the mono pannel
- EBV IgM and IgG viral capsid antigens
- EBDNA
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
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
rubella si/sx
- rash + low grade fever
- sx last 2-3 days
- old kids/ adults may have LAD and arthrlagias
how is rubella transmitted
- airborne
- is included in prenatal screen
complications of rubella
- birth defects in pregnant women:
- deafness
- cataracts
- heart defects
- developmental delay
- liver and spleen damage
what is another name for rubella
- germen measles
what causes roseola
- HHV6 and HHV7
- can be transmitted vertically
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
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
what vessels are impacted long term from kawasaki’s
- coronary arteries
who typically gets kawasaki’s
- < 5 y/o
- more commonly boys
- increased risk in asian and pacific islanders
pathophys of kawasaki’s
- neutrophilic infiltrate in vessel walls
- edema of endothelial SMC of vessel walls
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
rash of kawasaki’s
- erythema
- desquamation
- polymorphous: macular, morbilliorm, targetoid
- NOT vescicular or bullous
where does desquamation occur in kawasaki’s
- periungual
- perineal
- sheet like losses
mucositis of kawasaki’s
- fissured lips
- injected pharynx
- strawberry tongue
diagnosis of kawasaki’s
- clinical*
- +/- elevated ESR, CRP, plt
- normochromic/ cytic anemia
- +/- elevated transaminases
- UA: WBC without infection
- each pt needs echo**
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
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
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
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
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
coronary complications of kawasaki’s
- HF
- ischemia or infarction
- arrhythmias
- arterial thrombosis
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
what is another name for coxsackie
- hand, foot, mouth
what causes coxsackie and how is it transmitted
- enterovirus
- fecal oral transmission
- risk of spread to close contacts
presentation of coxsackie
- apthous stomatitis*- in back of mouth
- rash on hands and feet
- fever
- possible aseptic meningitis
diagnosis of coxsackie
- clinical
treatment of coxsackie
- symptomatic
- tylenol or motrin
- magic mouthwash: benadryl + maalox, add viscous lido if > 2
- correct dehydration
what is the varicella vaccine
- varivax
- can get attenuated illness since it is a live vaccine
- need bosters
what does varicella look like
- dew drop on rose petal appearance
treatment for varicella
- symptomatic
- motrin or tylenol for fever
- benadryl, aveeno for itch
- if high risk consider antivirals
rare complications of varicella
- encephalitis
- pneumonia
- bronchitis
- post herpetic neuralgia rare in kids
where does varicella live dormant
- dorsal root gangia
- trigeminal nerve
what is enuresis
- involuntary urination
- nocturnal= bed wetting
treatment for enuresis
- DDAVP to increase ADH
- moisture alarms
- scheduled voiding
- decreased bladder stimulants like caffeine
- limit fluid intake before bed
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
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
UTI in teens
- STI or sexually transmitted until proven it is not
- e coli, proteus
- urinate after intercourse if female
