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Peds > peds23 > Flashcards

peds23 Flashcards

1
Q

management for NLD obstruction

A

observation for most kids (half resolve), nasolacrimal massage, topical antibiotics if infected; NLD probing through hasner’s valve into nose

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2
Q

amniotocele (dacryocele)

A

swelling of the nasolacrimal sac

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3
Q

cause of amniotocele

A

accum of fluid due to NLD obstruction

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4
Q

clinical features of amniotocele

A

blusih swelling in the medial canthal area may be apparent and represents fluid sequestered withn the nasolacrimal sac; infection may occur

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5
Q

management of amniotocele

A

local massage if no evidence of infection; IV antibiotics and urgent NLD probing if infections

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6
Q

retinal hemorrhages

A

highly suggestive of child abuse! Nonabuse causes include birth trauma, leukemia, incr ICP, malignant htn, bacterial endocarditis, immune thrombocytopenia purpura, and, rarely, cardiopulm resuscitation

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7
Q

clincal features of retinal hemorrhage

A

hemorrhagic dots and blots, or hemorrhage within the preretinal vitreous on a dilated fundoscopic exam

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8
Q

corneal abrasion

A

cause is traum, incl injury from contact lens; pain, tearing, and photophobia. Also foreign body sensation

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9
Q

diagnosis of corneal abrasion

A

identification on fluorescein staining of the cornea

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10
Q

management of corneal abrasion

A

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

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11
Q

hyphema

A

blood within the anterior chamber

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12
Q

causes of hyphema

A

blunt trauma is most frequent cause; other causes are iris neovascularization and iris tumors

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13
Q

iris tumor

A

juvenile xanthogranuloma

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14
Q

clinical features of hyphema

A

impaired vision, blood-aquoeous fluid level

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15
Q

complications of hyphema

A

rebleeding 3-5 days after initial injury; glaucoma; staining of the cornea with blood; optic nerve damage in kids with sickle cell disease

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16
Q

management of hyphema

A

optho consult and bed rest for at least 5 days

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17
Q

orbital floor fracture due to what?

A

blunt trauma

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18
Q

clinical features of orbital floor fracture

A

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

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19
Q

enophthalmos

A

backward displacement of the eye

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20
Q

why would numbness of the cheek and upper teeth below the orbital fracture occur?

A

infraorbital nerve injury

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21
Q

management of orbital floor fracture

A

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

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22
Q

congenital glaucoma

A

incr intraocular pressure occuring at or soon after birth

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23
Q

adult glaucoma

A

pressure damages the optic nerve but does not change the size of the eye

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24
Q

congenital glaucoma

A

not only results in optic nerve injury but also expands the size of the eye; results in corneal edema, corneal clouding, and amblyopia

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25
Q

cause of congenital glaucoma

A

outflow of acqueous humor is reduced bc of maldevelopment of the trabecular meshwork (aut dom); other causes are infection or genetic syndromes

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26
Q

clinical features of glaucoma

A

tearing, photophobia, enlarged cornea, corneal clouding, and dull red reflex

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27
Q

glaucoma is often misdiagnosed as what?

A

NLD obstruction

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28
Q

bilateral glaucoma?

A

seen bilaterally in congenital glaucoma in 70% of patients

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29
Q

management of glaucoma

A

surgery to open outflow channels is almos always required; topical or systemic b-ags and carbonic anhydrase inhib, may help lower pressure

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30
Q

prognosis for congenital glaucoma

A

if not detected and surgically treated early, leads to blindness

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31
Q

retinopathy of prematurity

A

proliferation of vessels in premature infants exposed to oxygen

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32
Q

late complications of ROP

A

myopia, astigatism, amblyopia, strabismus, and blindness

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33
Q

management of ROP

A

optho exams every 1-2 weeks to monitor prgoress; if disease is severe, retinal cryotherapy and laser therapy may be effective

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34
Q

two most impt ways to prevent ROP

A

limit oxygen delivered and effective treatment of hyaline membrane disease

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35
Q

who should get a dilated optho exam at 4-6 weeks of age

A

infants born at less than 28 weeks or less than 1500 g

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36
Q

leukocoria

A

white pupil; refers to opacity at or behind the pupil; can be caused by cataract, opacity within the vitreous, or retinal disease like retinoblastoma

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37
Q

congenital cataract

A

crystalline opacity of the lens present at birth

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38
Q

most common cause of cataract?

A

idiopathic

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39
Q

genetic syndromes that can cause cataracts

A

down, noonan, marfan, alport, and smith-lemli-opitz syndrome

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40
Q

what metabolic derangements can cause cataracts

A

hypoglycemia, galactosemia, and DM

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41
Q

what intrauterine infections can cuase cataracts?

A

CMV and rubella

42
Q

can trauma cause cataracts?

A

yes

43
Q

management of cataracts

A

early surgery to prevent amblyopia

44
Q

prognosis for congenital cataract

A

treated within the first few weeks of life- good prognosis; but surery performed later is associated with poor visual outcome

45
Q

most common ocular malignancy in childhood

A

retinoblastoma

46
Q

average age of presentation of retinoblastoma

A

13-18 months. More than 90% of cases dx before 5 years of age

47
Q

genetics of retnoblastoma

A

mutation or deletion of growth supp gene on both alleles on the long arm of chrom 13; two hit model

48
Q

two most common presenting signs of retinoblastoma

A

leukocoria and strabismus

49
Q

hallmark of retinoblastoma?

A

calcification within the tumor identified on imaging studes of the eye

50
Q

management of retinoblastoma

A

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

51
Q

starbismus

A

misalignment of the eyes

52
Q

esotropia

A

eye turned nasally

53
Q

exotropia

A

eye turned laterally

54
Q

vertical strabismus

A

eye turned up or down

55
Q

pseudostabismus

A

prominence of the epicanthal folds that results the false appearance of stabismus

56
Q

if strabismus occurs before age 6

A

child suppresses the image in the deviated eye and amblyopia may result

57
Q

if strabismus occurs after age 6

A

the mature visual system can’t suppress the image and diplopia develops

58
Q

management

A

ocular patching to prevent amblyopia; corrective lenses if farsighted; surgery if misalignment does not respond to patch or glasses

59
Q

when is fifth disease no longer contagious?

A

when facial rash appears

60
Q

management of fifth disease

A

supportive. IV IG can be used to treat chronic anemia in immunosupp patients

61
Q

roseola infantum

A

aka exanthem subitum

62
Q

roseloa most common in what agr

A

under 2

63
Q

what causes roseola?

A

HHV 6 and 7; other causes ar adenovirus, parvi, b19, and echovirus 16

64
Q

clinical features of roseola

A

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

65
Q

management of roseola infantum

A

supportive

66
Q

gianotti-crosti syndrome

A

papular acrodermatitis; associated with hep B infection, EBV, CMV, and coxsackievirus

67
Q

clinical features of gianotti-crosti syndrome

A

red or flescolored papules in acral areas; URI symptoms may precede the eruption; treatment is supportive

68
Q

clinical features of varicella

A

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)

69
Q

management of varicella

A

antipyretics, cleansing with antibacterial soaps; antihistamines for itching; acyclovir for varicella pneumonia and encephalitisi or in eyes for eye involvement

70
Q

most common HSV infection during infancy

A

gingiostomatitis, almost always caused by hsv 1

71
Q

characteristic lesions for hsv

A

grouped vesicles on an erythematous base

72
Q

hsv gingivostamatitis

A

young infants with grouped vesicles and ulcers on the lips, mouth, tongue

73
Q

neonatal hsv

A

first week of life; may have just a few vesicles; serious sequelae include meningoencephalitis, hepatitis, sepsis, shock and death; hsv2 more common than hsv1

74
Q

herpetic whitlow

A

hsv-1 infection; of the thumb or fingers (usually 2/2 thumb sucking by kid with oral hsv lesion)

75
Q

where does hsv reside?

A

dorsal root ganglion; can reactivate

76
Q

recurrent hsv lesions?

A

more mild and less symptomatic; generally occur on lip

77
Q

how to diagnose hsv?

A

tzanck preparation, by detection of hsv antigen on fluorescent antibody testing, or culture of base of lesion; pcr of cerebrospinal fluid

78
Q

management of hsv

A

neonatal hsv is medical emergency! Iv acyclovir; cutaneous and oral hsv may be treated with oral acyclovir promptly

79
Q

hand-foot-mouth disease

A

coxsackievirus

80
Q

clinical features of hand-foot-mouth diseae

A

vesicles, papules, or pustules on the palms, soles, fingers, and shallow ulcer on the soft palate or tongue

81
Q

if only oral lesions are present in hand-foot-mouth disease, what do you call it?

A

herpangina

82
Q

management of herpangina or hand foot mouth

A

supportive

83
Q

what causes warts?

A

hpv

84
Q

condylomata acuminata

A

term to describe multiple external warts in the genital area

85
Q

management of warts

A

resolve spontaneously in 1-2 years; can treat but recurrance after treatment is high

86
Q

molloscum cantagiosum is caused by what?

A

pox virus

87
Q

molloscum features

A

flesh-olored papules with central umbilication

88
Q

what disease is associated with eruption of molluscum

A

hiv infection

89
Q

management of molluscum

A

just watchful waiting; can remove like wart

90
Q

louse infestation

A

pediculus humanus (head and body lice) and phthirus pubis (pubic lice)

91
Q

louse associated with what?

A

crowded living conditions, sharing hats, clothes, combs

92
Q

body lice

A

papules and pustules on the trunk with excoriations

93
Q

pubic lice

A

lice or nits in the groin and blackcrusted papules or blue macules (macula cerulea)

94
Q

management of head lice

A

permethrin shampoo and comb

95
Q

management of body and pubic lice

A

12 hours application of hexachloride lotion

96
Q

scabies caused by what?

A

mite named sarcoptes scabei

97
Q

clinical features of scabies

A

pruritic papules or vesicles all over body; severe itchign and S shaped burrows

98
Q

management of scabies

A

overnight applic of permethrin lotion or lindane (adults only); highly contagious so treat all household contacts; wash all sheet and clothes

99
Q

causes of hypopigmentation

A

postinflamm; pityriasis alba; vitiligo; oculocutaneous albinism

100
Q

postinflamm hypopigmentation caused by what and resolves in how long?

A

may follow any skin inflamm (like atopic dermatitis) and resolves in months to years

Peds (99 decks)

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