STUDY GUIDE- EXAM 2 Flashcards
anemia (3 q’s)
sickle cell (2 q’s)
murmurs (4 q’s)
chest pain (2 q’s)
Chest pain common complaint; rarely serious
Most common – musculoskeletal origin
Chronic chest pain – usually psychogenic
Chest pain with cardiac cause usually consistent over time
chest pain history?
Past medical/family history of sudden death, heart disease, asthma, Marfan syndrome, SCD
Past sports activities
Previous trauma/muscle strains
Characteristics of chest pain
Relation to exercise, syncope, dyspnea
OLDCARTS
chest pain physical exam?
Cardiac murmur, rubs, clicks
Point tenderness of one or more costochondral joints
Irregular heart rhythm
Shortness of breath, coughing, wheezing
Rales, wheezing, tachypnea
chest pain dx?
Febrile, pulmonary, cardiac condition – CXR
Exercise-induced asthma – PFT
Rhythm disturbance – Holter monitor/stress test
Signs of CHD, pericarditis, myocarditis – ECG
chest pain differential dx?
Costochondritis, Tietze syndrome, idiopathic pain, precordial catch syndrome, other musculoskeletal
Esophagitis, foreign body ingestion, exercise-induced bronchospasm
Management
chest pain?
Reassurance after serious causes ruled out
Refer to pediatric cardiology for
Chest pain that worsens with exercise; angina
Positive findings on examination, ECG, CXR
Concerning personal/family history
blood pressure (2 q’s)
Systolic/diastolic/both >95th percentile
Take BP on three separate occasions
High-normal/prehypertensive >90th percentile
> 95th to 99th percentile
HTN
stage I
> 99th percentile
stage 2 HTN
HTN
Increasing risk related to obesity
Secondary hypertension usually under age 6
History HTN
Assess whether primary or secondary
Neonatal history of prolonged mechanical ventilation, prematurity, SCA
Prior hospitalizations, trauma
Diet, activity, smoke exposure
Sleep history/sleep apnea
Medications
Chronic illnesses, history of UTI
Headache, chest pain, dyspnea, muscle weakness, palpitations
Family history of MI, stroke, HTN, others
Physical exam HTN
Body habitus, overweight, metabolic syndromes
Dysmorphic features
Edema, pallor, flushing, skin lesions of tuberous sclerosis, SLE, neurofibromatosis
Upper/lower extremity central pulses
Fundi, thyroid, abdominal mass, flank bruit, visual acuity, facial palsy
Elevated BP
DX studies HTN
Laboratory evaluation for underlying causes
If <10 years with secondary HTN: CBC, ESR, CRP, UA/culture, electrolytes, BUN, creatinine, plasma renin, renal nuclear scans, renal US
If renal vascular disease suspected, refer to pediatric nephrologist
Echocardiogram if cardiac involvement
Management of BP HTN
BP annually all children 3 years and older
Prehypertension: two follow-up BPs
Hypertension: if overweight: treatment of obesity with lifestyle changes. Refer to nephrologist if HTN persistent
Medication management
Complications
HTN?
Increased left ventricular mass, other heart changes; renal disease
Lifestyle changes should be taught
cholesterol (2 q’s)
Clinical findings – does not usually present in children; screen those at risk
History – family history of premature heart disease, males, hypertension, DM, smoking, reduced HDL
Physical examination – tendon xanthomas, arcus corneae, tuberous xanthomas
Diagnostic studies – lipoprotein analysis; universal screening for all 9-11 years old
Management
HTN?
Lifestyle changes – dietary, exercise; clinical dietician referral
Pharmacotherapy – in children >10 years who continue to have elevated LDL and various risk factors after 6-12 months of lifestyle changes
HMG-CoA reductase inhibitors (statins) for severe hypercholesterolemia >10 yrs. old.
Younger children refer to lipidologist.
Multiple treatment options.
Refer to lipidologist for initiation of pharmacologic therapy.
hordelolum/chalazion (1 q)
27 Chalazion
- Chronic, sterile inflammation of eyelid caused by lipogranuloma of meibomian glands
- Deeper in tissue than hordeolum
- Starts as a slightly reddened and swollen area to eyelid that, after a few days, the redness resolves leaving a round, flesh colored, painless mass/nodule that is slow-growing
- Differential dx:
- hordeolum, blepharitis, sebaceous cell cancer
- Management:
- warm compresses
- Refer to ophthalmologist
*
25 Hordeolum (Stye)
- Infection of the sebaceous gland, eyelid(s) (external), or meibomian glands of eyelid (internal)
- S. aureus or P. aeruginosa
- Tender, edematous, erythematous furuncle at the upper/lower lid margin and may point through the skin
- Differential dx: blepharitis, chalazion, lid cellulitis, granuloma, sebaceous cell cancer
Management of Stye?
- Management:
- furuncle may rupture on own
- warm compresses TID-QID x 10-15 min to facilitate rupturing
- cleanse eyelids/lashes with weakened no-tear shampoo
- erythromycin ophthalmic ointment 0.5% TID-QID x 7-14d
- if recurrent, non-resolving, or enlarging hordeolum - refer to ophthalmologist
conjunctivitis (3 q’s) -look up YouTube videos
this is also called pink eye
conjunctivitis “pink eye”
inflammation of the conjunctiva causes redness, swelling, drainage, very common and contagious
conjunctivitis what are some prevention measures?
wash hands
avoid sharing cosmetics
avoid touching face
change bedding frequently
newborn conjunctivitis?
opthalmia neonatorum- if the baby is exposed to chlamydia or gonorrhea
when babies are born we prophylactically administer erythromycin
what are some symptoms of pink eye?
redness, itching, swollen eyelids, crusting of the eyelids that can cause them to be glued shut
bacterial conjunctivitis has?
purulent drainage
treatment for bacterial conjunctivitis
ophthalmic antibiotic drops
How is conjunctivitis contracted?
direct contact with fingers or objects to the eyes
resp secretions or contaminated eye drops
What are the symptoms of conjunctivitis?
itchiness
tearing
redness
stringey discharge
swelling
There are three types of conjunctivitis?
viral
bacterial
allergic
& assessing discharge is important
What are the tests for conjunctivitis?
schemer test
immunologic tests
exam of stained conjunctival strappings
viral conjunctivitis may not require treatment
use of cold compresses and artificial tears to reduce discomfort
How do you clean Childs eye with conjunctivitis?
clean Childs eye inner canthus outward
remove crust that form with warm moist compresses
What is a risk factor for ROP?
Retinopathy of prematurity
excessive O2
visual screening (1 q)
- Red reflex (darken room)
- Visual acuity testing (started at 4 yrs old; if glasses/contacts, measure with corrective lenses)
- Color vision testing - not routinely administered
- Peripheral vision testing (checks function of CN II)
- Ocular mobility and alignment - corneal light reflex (evaluate extraocular muscles); cover/uncover test (checks alignment)
- Extraocular muscle functioning - corneal light reflex and cover tests
Myopia (Nearsightedness)
Distance blurred
- Objects nearby are in focus; those at a distance are blurred
- Onset is typically in elementary school age patients and progresses throughout adolescence
- Treatment requires glasses or contact lenses
- Daily use of low dose atropine 0.01% eye drops has been shown to slow myopia progression by approx. 50% - side effects include minimal pupil dilation and loss of accommodation without reduction in visual acuity
Hyperopia (Farsightedness
- Sees clearly both at a distance and at near because the child can focus on near objects through the process of accommodation if the hyperopia is not excessive
- Large amounts of uncorrected hyperopia can cause estropia (crossed eyes) as accommodation and convergence are closely
linked
* Typically diminishes with age and does not require glasses
acute otitis media (4 q)
otitis media effusion (2 q’s)
∙ Middle ear fluid w/o s/sx AOM
∙ Decreased TM mobility
∙ Decreased sound/hearing
∙ Refer to ENT after 3 months w/o resolution in otherwise healthy child
What does the fluid in the ear look like? otitis media effusion?
clear amber colored or opaque
True or false otitis media effusion can turn into otitis media?
true