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Clin Med Peds > Various Peds Disorders > Flashcards

Various Peds Disorders Flashcards

1
Q

what is a strabismus?

A

poor ocular alignment

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2
Q

when must you treat a strabismus?

A

as a child b/c can’t correct it once an adult

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3
Q

latent strabismus is…

A

phobia

present when fixation interrupted

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4
Q

manifest strabismus is…

A

tropia

present w/out interruption of gaze

can be intermittent or constant and monocular or alternating

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5
Q

strabismus can be a normal variant in…

A

newborns

don’t dx strabismus in early infancy

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6
Q

what are RF’s of primary strabismus?

A
  • fam hx
  • low birth weight
  • muscular abnormality
  • visual deprivation (retinopathy of premie - premie neuro compromise)
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7
Q

how do you dx a strabismus?

A

Complete hx (need to know if injury to eye)

Complete PE

  • corneal light reflex (Hirschbeerg)
  • Cover/uncover
  • bruckner red reflex
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8
Q

what are 4 complications of a strabismus?

A

(1) Amblyopia (“lazy eye”
(2) Diplopia (in acquired strabismus >3 y/o)
(3) Contracture of EOMs
(4) Psychosocial and vocational consequences

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9
Q

what’s the medical treatment for a strabismus?

A
  • prescription glasses w/ and w/out prism
  • miotic drops
  • patching
  • visual training exercises
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10
Q

what’s the surgical treatment for a strabismus?

A

repositioning or shortening

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11
Q

refer patients with strabismus to…

A

ophthalmologist

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12
Q

definition of impetigo

A

contagious superficial bacterial infection

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13
Q

primary impetigo vs secondary impetigo

A

Primary = direct bacterial invasion of nl skin

Secondary = infection at site w/previous mild trauma

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14
Q

who gets impetigo?

A

kids 2-5 y/o (M/C)

worse in summer (warm and humid conditions)

spread easily to close contacts

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15
Q

how contagious is impetigo?

A

VERY CONTAGIOUS

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16
Q

what causes impetigo?

A

Staph aureus

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17
Q

what are the 3 types of impetigo?

A

(1) Non-bullous
(2) Bullous
(3) Ecthyma

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18
Q

what’s the most common type of impetigo?

A

Non-bullous

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19
Q

how does Non-bullous Impetigo present?

A

papule-vesicles surrounded by erythematous pustules that break and become thick adherent crust with GOLDEN “HONEY COLORED” appearance

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20
Q

where is Non-Bullous Impetigo usually on the body?

A

face and extremities

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21
Q

how does Bullous Impetigo present?

A

vesicles enlarge to form flaccid bullae w/clear yellow fluid that then rupture to form thin BROWN CRUST

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22
Q

where is Bullous Impetigo usually on the body?

A

trunk

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23
Q

how does Ecthyma Impetigo present?

A

Ulcerative form of impetigo

Lesions extend thru epidermis into deep dermis

Causes “PUNCHED OUT” ULCERS COVERED WITH YELLOW CRUST

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24
Q

dx of Impetigo

A

clinical -> TREAT EMPIRICALLY

culture fluid or base of lesion if tx fails

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25
Q

what are you treating in Impetigo?

A

Staph Aureus and Strep A

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26
Q

2 types of tx for Impetigo?

A

topical and oral tx’s

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27
Q

what is the topical tx of Impetigo and when is it used?

A

Mupirocin (bactroban)

use if simple impetigo - limited number of lesions

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28
Q

what are the oral tx’s of Impetigo and when are they used?

A
  • Diclox
  • Cephalexin
  • Clindamycin (tastes bad so may not use)
  • Bactrim if MRSA suspected

Use if bullae, multiple lesions

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29
Q

what are pinworms caused by?

A

Enterobius Vermicularis

pinworms aka eterobiasis

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30
Q

pinworms inhabit the…

A

cecum, appendix, ileum, ascending colon

LOWER INTESTINAL INFECTION

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31
Q

how do pinworms spread?

A

fecal oral route b/c so itchy

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32
Q

who are the ONLY known hosts of pinworms?

A

humans

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33
Q

what are s/s of pinworms?

A

nocturnal perianal and perineal itching

visible worms around anus and on butt

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34
Q

how do you dx of pinworms?

A

hx of the nocturnal itching or early morning itching

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35
Q

what is the tx for pinworms?

A

Albendazole (Albenga)

  • single tx
  • 400mg once (all ages) and repeat in 2 weeks

Can also use: Pyrantel Pamoate -> OTC and cheap!!!

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36
Q

what is erythema infectiousum (fifth disease) caused by?

A

Parvovirus B19

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37
Q

what’s important about the transmission of fifth disease? when does transmission stop?

A

unknown transmission

high transmission rates w/in households

rate of transmission stops after symptoms develop; no transmission after rash (rash not contagious)

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38
Q

symptoms of fifth disease (Day 1-2, Day 2-5)

A

Day 1-2: fever, HA, nausea, diarrhea

Day 2-5: RASH (slapped cheeks, reticulated (Lacey) rash on trunks/extremities

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39
Q

symptoms of fifth disease may repeat with…

A

sunlight, heat changes, exercise, stress

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40
Q

symptoms of fifth disease may linger…

A

weeks to months (NOT DANGEROUS)

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41
Q

what’s the tx of fifth disease?

A

supportive -> TREAT THE FEVER

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42
Q

what else can Parvovirus B19 cause that is dangerous?

A

Fetal hydrops - fetal demise

Ask mom if she should be pregnant b/c then want mom to stay away from kid with fifth disease

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43
Q

infectious mononucleosis is in what viral family?

A

EBV - widely disseminated herpesvirus

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44
Q

when is mono usually acquired?

A

in childhood as a subclinical and undiagnosed entity

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45
Q

what are the 3 reasons there may be a negative test for mono?

A

(1) did mono test too soon
(2) don’t have mono
(3) not every test is positive (high rate of false negatives)

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46
Q

mono is a ___ dx

A

clinical dx

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47
Q

mono virus shed is what secretions?

A

salivary secretions

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48
Q

is mono virus transmitted breast milk?

A

NO!! but it is found there

49
Q

what’s the incubation period of mono?

A

4-7 weeks

as incubating, becoming contagious to those around you

50
Q

what are clinical manifestations of mono?

A
  • Fever
  • Pharyngitis (pharyngeal erythema, exudates, petechiae)
  • ***Posterior Cervical Adenopathy
  • ***Early atypical lymphocytosis in blood work

-Splenomegaly

51
Q

what’s mono associated with?

A

strep -> give penicillin/amox for strep and patient gets maculopapular, urticarial, petechial rash

mono is making the patient more susceptible to the amox rash

52
Q

what is something you less commonly see with mono?

A

splenic rupture - post-trauma

53
Q

how do you dx mono?

A

clinical dx

atypical lymphocytes >10% on diff (indicative but NOT pathognomonic)

Heterophile Ab = Monospot (horse RBC agglutination)

54
Q

if patient has symptoms and findings c/w mono and the monospot is negative after retesting 1 week later, what should you consider doing?

A

EBV panel (EBV IgM and IgG VCA and EBNA)

55
Q

what’s the tx of mono?

A

Supportive
-maintain hydration, antipyretics

Steroid if airway compromised by tonsillar hypertrophy

***REST!!!

56
Q

patients with mono must take what precautions?

A

Splenic Rupture Precautions

  • 3 weeks mild activity
  • minimum 4 weeks for contact/high risk sports and activities
57
Q

is there antiviral tx indicated for mono?

A

NO!!! NO ANTIVIRAL TX INDICATION

58
Q

what is measles aka?

A

rubeola

59
Q

what are sx’s of measles?

A

fever, cough, coryza, conjunctivitis

KOPLIK SPOTS (white spots on buccal mucosa) then maculopapular rash (14 days post exposure) -> head to toe

60
Q

what is PATHOGNOMONIC for measles?

A

Koplik spots

61
Q

when is measles contagious?

A

4 days before through 4 days after rash

62
Q

what is measles caused by?

A

double stranded RNA virus (morbillivirus), thus rash is “morbilliform”

63
Q

what are common complications of measles?

A

OM, pneumonia, croup, diarrhea

64
Q

what are less common complications of measles but are more serious?

A

encephalitis (permanent damage), respiratory or neuro complications causing death, sclerosis panencephalitis

65
Q

how contagious is measles?

A

VERY CONTAGIOUS

66
Q

how is measles transmitted?

A

direct contacts with droplets or airborne

can remain on surfaces up to 2 hours

67
Q

what are labs for measles?

A

Measles IgM antibody, measles RNA by PCR

-serum and NP swab (or urine)

68
Q

what’s the measles post-exposure ppx?

A

MMR vaccine w/in72 hrs of exposure or IG if administered w/in 6 days of exposure

69
Q

measles is a ___ illness

A

reportable illness

70
Q

what’s the treatment for measles? why is this the treatment?

A

Vitamin A - admin immediately on dx and repeat the next day

this is the tx b/c it causes Vitamin A deficiency which can lead to dry dry which can cause permanent blindness if very dry

71
Q

German Measles aka

A

Rubella

72
Q

what causes German Measles?

A

virus

73
Q

what are symptoms of German Measles?

A

rash and low grade fever with sx’s lasting 2-3 days

doesn’t make you as sick as rubeola

74
Q

if pregnant, then what screening do you need?

A

rubella screening b/c can cause fetal demise

75
Q

complications of rubella?

A

birth defects in pregnant woman

76
Q

what is roseola?

A

exanthema subitum = sudden rash

77
Q

what causes roseola?

A

HHV-6 and HHV-7 (human herpes virus)

78
Q

how can roseola be transmitted?

A

vertically

79
Q

what are s/s of roseola?

A

sudden high fever (102-104) -> fever subsides -> rash appears

rash trunk to arms and legs

rash is aysmptomatic

80
Q

is there a test for roseola?

A

no!!!

81
Q

if a child has a fever >5 days w/out a clear source, what do you need to think about?

A

Kawasaki’s Disease

82
Q

Kawasaki’s disease aka…

A

Mucocutaneous Lymph Node Syndrome

83
Q

what is Kawasaki’s disease?

A

Widespread inflammation of medium sized blood vessels throughout the body

it’s a VASCULITIS

84
Q

what vessels does Kawasaki’s disease most importantly affect? this causes what?

A

coronary arteries -> causes coronary arteritis which can cause coronary artery aneurysms

85
Q

what is the M/C childhood vasculitis?

A

Kawasaki’s disease

86
Q

what ages is Kawasaki’s Disease seen in?

A

1-5 y/o

87
Q

etiology of Kawasaki’s Disease?

A

unknown

-maybe infectious or genetic b/c seen in asian and Pacific Islanders

88
Q

Kawasaki’s Disease Pathogenesis

A

Neutrophilic infiltrate observed in medium vessel walls

-causes edema in the vessels

89
Q

what are Kawasaki’s Disease clinical manifestations?

A

fever >5 days over 100.5, bulbar conjunctivitis, mucositis, rash, extremity changes, lymphadenopathy, CV findings (chest pain, tachy)

90
Q

is there a test for Kawasaki’s Disease?

A

NO!!!

91
Q

what’s the conjunctivitis like in KD?

A

non-exudative, bilateral, spares the limbus

bulbar conjunctivitis

92
Q

what’s the mucositis like in KD?

A

cracked red lips, strawberry tongue

93
Q

what’s the rash like in KD?

A

polymorphous

begins perineal with erythema and then peels (desquamations)

then may be macular/morbilliform/targetoid

94
Q

what are the extremity changes in KD?

A

swelling of hands and feet, diffuse erythema of hands, palms, and soles

arthritis (infrequent, but in large joints - knee, hip, ankle)

sheet like desquamation of skin

95
Q

what are Beau’s lines in KD?

A

linear nail creases (not pathognomonic for KD)

96
Q

what’s the lymphadenopathy like in KD

A

single in neck

large >1.5 cm in diameter

97
Q

what is the biggest risk of KD?

A

cardiovascular problems

Day 5-10: tachycardia out of proportion to fever

muffled heart sounds, brachial aneurysms

98
Q

what are later CV complications of KD?

A

Coronary artery aneurysm, MI, arrhythmias

99
Q

how do you dx KD?

A

clinical, but get labs

may have elevated ESR and CRP, elevated platelet count

normocytic/normochromic anemia, elevated LFTs

UA: WBC’s = pyuria w/out infection

100
Q

each patient with KD dx will have what imaging done?

A

cardiac echo to detect CA aneurysms

also will have repeat in 4-6 weeks to document resolution

101
Q

tx for KD

A

admit all patients for inpatient monitoring, specifically for CV fxn

IVIG = hallmark of tx

Aspirin (ASA) = hallmark of tx

cardiology consult

102
Q

what tx of KD dramatically decreases risk of CA aneurysm?

A

IVIG

103
Q

kid with KD must have what consult at dx?

A

cardiology consult at dx

104
Q

what can pt with KD that’s treated with IVIG not have for 11 months?

A

live virus vaccines d/t passive immunity

105
Q

if coronary artery disease from KD with dilatation <8mm, what’s the risk of morbidity? what about >8mm?

A

<8mm -> morbidity is low

> 8mm -> morbidity is high

106
Q

what is coxsackie disease?

A

hand, foot, and mouth disease

107
Q

what is coxsackie disease caused by? transmission?

A

enterovirus

transmitted by fecal-oral

108
Q

what is the MOST LIKELY presentation of Coxsackie disease?

A

Apthous stomatitis (sores in mouth)

Rash on hands and feet

Fever

109
Q

tx of Coxsackie disease?

A

symptomatic - Tylenol or motrin, magic mouthwash for sores

110
Q

what is the classic presentation of chicken pox? stages of vesicles?

A

dew drop on rose petal

multiple stages of vesicles:
vesicles -> open lesions -> scabs (once scabs not contagious anymore)

111
Q

tx for chicken pox?

A

symptomatic - motrin/tylenol for fever, Benadryl or aveeno for itch

if high risk pt, may give acyclovir, calcyclovir

112
Q

complications of chicken pox?

A

RARE:

-encephlitis, pneumonia, bronchitis (b/c these lesions are also on organs as well as skin)

113
Q

where does the varicella (VZV) virus lie?

A

latent in dorsal root ganglia and trigeminal nerve

114
Q

what is enuresis?

A

involuntary urination

115
Q

what is nocturnal enuresis?

A

bedwetting

116
Q

med tx of nocturnal enuresis?

A

nasal spray DDAVP (vasopressin) -> increase ADH -> decrease in urine output

117
Q

non-med tx of nocturnal enuresis?

A

moisture alarms, scheduled voiding (go pee before bed), decrease bladder stimulants like caffeine, limit fluid intake before bed

118
Q

causes of UTIs in infants? need what specimen? caused by what bacteria? how do you treat and work up?

A

anatomical abnormalities -> Vesicoureteric reflux (urine refluxing back into ureter)

NEED catheterized specimen

caused by E. coli

treat and then work-up first in male or female

119
Q

causes of UTIs in teens? caused by what bacteria?

A

STI or sexually related until proven otherwise

caused by E. coli ports (won’t show on culture)

Clin Med Peds (10 decks)

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