peds23 Flashcards
management for NLD obstruction
observation for most kids (half resolve), nasolacrimal massage, topical antibiotics if infected; NLD probing through hasner’s valve into nose
amniotocele (dacryocele)
swelling of the nasolacrimal sac
cause of amniotocele
accum of fluid due to NLD obstruction
clinical features of amniotocele
blusih swelling in the medial canthal area may be apparent and represents fluid sequestered withn the nasolacrimal sac; infection may occur
management of amniotocele
local massage if no evidence of infection; IV antibiotics and urgent NLD probing if infections
retinal hemorrhages
highly suggestive of child abuse! Nonabuse causes include birth trauma, leukemia, incr ICP, malignant htn, bacterial endocarditis, immune thrombocytopenia purpura, and, rarely, cardiopulm resuscitation
clincal features of retinal hemorrhage
hemorrhagic dots and blots, or hemorrhage within the preretinal vitreous on a dilated fundoscopic exam
corneal abrasion
cause is traum, incl injury from contact lens; pain, tearing, and photophobia. Also foreign body sensation
diagnosis of corneal abrasion
identification on fluorescein staining of the cornea
management of corneal abrasion
ealing usually in 24-48 hours; placement of patch for that time is recommended in severe cases; topical antibiotic to prevent bacterial superinfection; optho consult if abrasion associated with contact lense
hyphema
blood within the anterior chamber
causes of hyphema
blunt trauma is most frequent cause; other causes are iris neovascularization and iris tumors
iris tumor
juvenile xanthogranuloma
clinical features of hyphema
impaired vision, blood-aquoeous fluid level
complications of hyphema
rebleeding 3-5 days after initial injury; glaucoma; staining of the cornea with blood; optic nerve damage in kids with sickle cell disease
management of hyphema
optho consult and bed rest for at least 5 days
orbital floor fracture due to what?
blunt trauma
clinical features of orbital floor fracture
orbital fat and inferior rectus muscl can become trapped in the fracture and lead to diplopia due to restricted vertical eye movement, to strabismus, and to enophthalmos
enophthalmos
backward displacement of the eye
why would numbness of the cheek and upper teeth below the orbital fracture occur?
infraorbital nerve injury
management of orbital floor fracture
empiral oral antibiotics to prevent max sinus organisms from getting to the orbit; also surgical repair if diplopia persists 2-4 wks after injury or if enophthalmos is signif
congenital glaucoma
incr intraocular pressure occuring at or soon after birth
adult glaucoma
pressure damages the optic nerve but does not change the size of the eye
congenital glaucoma
not only results in optic nerve injury but also expands the size of the eye; results in corneal edema, corneal clouding, and amblyopia
cause of congenital glaucoma
outflow of acqueous humor is reduced bc of maldevelopment of the trabecular meshwork (aut dom); other causes are infection or genetic syndromes
clinical features of glaucoma
tearing, photophobia, enlarged cornea, corneal clouding, and dull red reflex
glaucoma is often misdiagnosed as what?
NLD obstruction
bilateral glaucoma?
seen bilaterally in congenital glaucoma in 70% of patients
management of glaucoma
surgery to open outflow channels is almos always required; topical or systemic b-ags and carbonic anhydrase inhib, may help lower pressure
prognosis for congenital glaucoma
if not detected and surgically treated early, leads to blindness
retinopathy of prematurity
proliferation of vessels in premature infants exposed to oxygen
late complications of ROP
myopia, astigatism, amblyopia, strabismus, and blindness
management of ROP
optho exams every 1-2 weeks to monitor prgoress; if disease is severe, retinal cryotherapy and laser therapy may be effective
two most impt ways to prevent ROP
limit oxygen delivered and effective treatment of hyaline membrane disease
who should get a dilated optho exam at 4-6 weeks of age
infants born at less than 28 weeks or less than 1500 g
leukocoria
white pupil; refers to opacity at or behind the pupil; can be caused by cataract, opacity within the vitreous, or retinal disease like retinoblastoma
congenital cataract
crystalline opacity of the lens present at birth
most common cause of cataract?
idiopathic
genetic syndromes that can cause cataracts
down, noonan, marfan, alport, and smith-lemli-opitz syndrome
what metabolic derangements can cause cataracts
hypoglycemia, galactosemia, and DM
what intrauterine infections can cuase cataracts?
CMV and rubella
can trauma cause cataracts?
yes
management of cataracts
early surgery to prevent amblyopia
prognosis for congenital cataract
treated within the first few weeks of life- good prognosis; but surery performed later is associated with poor visual outcome
most common ocular malignancy in childhood
retinoblastoma
average age of presentation of retinoblastoma
13-18 months. More than 90% of cases dx before 5 years of age
genetics of retnoblastoma
mutation or deletion of growth supp gene on both alleles on the long arm of chrom 13; two hit model
two most common presenting signs of retinoblastoma
leukocoria and strabismus
hallmark of retinoblastoma?
calcification within the tumor identified on imaging studes of the eye
management of retinoblastoma
large tumors involving the macula are treated by removing the eye; smaller tumors may be treated with external beam radiation (which may induce secondary tumors); very small peripheral tumors can be treated with cryotherapy or laser photocoagulation
starbismus
misalignment of the eyes
esotropia
eye turned nasally
exotropia
eye turned laterally
vertical strabismus
eye turned up or down
pseudostabismus
prominence of the epicanthal folds that results the false appearance of stabismus
if strabismus occurs before age 6
child suppresses the image in the deviated eye and amblyopia may result
if strabismus occurs after age 6
the mature visual system can’t suppress the image and diplopia develops
management
ocular patching to prevent amblyopia; corrective lenses if farsighted; surgery if misalignment does not respond to patch or glasses
when is fifth disease no longer contagious?
when facial rash appears
management of fifth disease
supportive. IV IG can be used to treat chronic anemia in immunosupp patients
roseola infantum
aka exanthem subitum
roseloa most common in what agr
under 2
what causes roseola?
HHV 6 and 7; other causes ar adenovirus, parvi, b19, and echovirus 16
clinical features of roseola
begins with 3-5 days of high fever; once the fever resolves, a pink papular eruption occurs in the trunk and fades in 24-48 hrs
management of roseola infantum
supportive
gianotti-crosti syndrome
papular acrodermatitis; associated with hep B infection, EBV, CMV, and coxsackievirus
clinical features of gianotti-crosti syndrome
red or flescolored papules in acral areas; URI symptoms may precede the eruption; treatment is supportive
clinical features of varicella
intensely pruriti erythematous macules develop after a 7 to 21 day incubation period; looks like a dew drop on a rose petal (vesicle on a red background)
management of varicella
antipyretics, cleansing with antibacterial soaps; antihistamines for itching; acyclovir for varicella pneumonia and encephalitisi or in eyes for eye involvement
most common HSV infection during infancy
gingiostomatitis, almost always caused by hsv 1
characteristic lesions for hsv
grouped vesicles on an erythematous base
hsv gingivostamatitis
young infants with grouped vesicles and ulcers on the lips, mouth, tongue
neonatal hsv
first week of life; may have just a few vesicles; serious sequelae include meningoencephalitis, hepatitis, sepsis, shock and death; hsv2 more common than hsv1
herpetic whitlow
hsv-1 infection; of the thumb or fingers (usually 2/2 thumb sucking by kid with oral hsv lesion)
where does hsv reside?
dorsal root ganglion; can reactivate
recurrent hsv lesions?
more mild and less symptomatic; generally occur on lip
how to diagnose hsv?
tzanck preparation, by detection of hsv antigen on fluorescent antibody testing, or culture of base of lesion; pcr of cerebrospinal fluid
management of hsv
neonatal hsv is medical emergency! Iv acyclovir; cutaneous and oral hsv may be treated with oral acyclovir promptly
hand-foot-mouth disease
coxsackievirus
clinical features of hand-foot-mouth diseae
vesicles, papules, or pustules on the palms, soles, fingers, and shallow ulcer on the soft palate or tongue
if only oral lesions are present in hand-foot-mouth disease, what do you call it?
herpangina
management of herpangina or hand foot mouth
supportive
what causes warts?
hpv
condylomata acuminata
term to describe multiple external warts in the genital area
management of warts
resolve spontaneously in 1-2 years; can treat but recurrance after treatment is high
molloscum cantagiosum is caused by what?
pox virus
molloscum features
flesh-olored papules with central umbilication
what disease is associated with eruption of molluscum
hiv infection
management of molluscum
just watchful waiting; can remove like wart
louse infestation
pediculus humanus (head and body lice) and phthirus pubis (pubic lice)
louse associated with what?
crowded living conditions, sharing hats, clothes, combs
body lice
papules and pustules on the trunk with excoriations
pubic lice
lice or nits in the groin and blackcrusted papules or blue macules (macula cerulea)
management of head lice
permethrin shampoo and comb
management of body and pubic lice
12 hours application of hexachloride lotion
scabies caused by what?
mite named sarcoptes scabei
clinical features of scabies
pruritic papules or vesicles all over body; severe itchign and S shaped burrows
management of scabies
overnight applic of permethrin lotion or lindane (adults only); highly contagious so treat all household contacts; wash all sheet and clothes
causes of hypopigmentation
postinflamm; pityriasis alba; vitiligo; oculocutaneous albinism
postinflamm hypopigmentation caused by what and resolves in how long?
may follow any skin inflamm (like atopic dermatitis) and resolves in months to years
