Various Peds Disorders Flashcards
what is a strabismus?
poor ocular alignment
when must you treat a strabismus?
as a child b/c can’t correct it once an adult
latent strabismus is…
phobia
present when fixation interrupted
manifest strabismus is…
tropia
present w/out interruption of gaze
can be intermittent or constant and monocular or alternating
strabismus can be a normal variant in…
newborns
don’t dx strabismus in early infancy
what are RF’s of primary strabismus?
- fam hx
- low birth weight
- muscular abnormality
- visual deprivation (retinopathy of premie - premie neuro compromise)
how do you dx a strabismus?
Complete hx (need to know if injury to eye)
Complete PE
- corneal light reflex (Hirschbeerg)
- Cover/uncover
- bruckner red reflex
what are 4 complications of a strabismus?
(1) Amblyopia (“lazy eye”
(2) Diplopia (in acquired strabismus >3 y/o)
(3) Contracture of EOMs
(4) Psychosocial and vocational consequences
what’s the medical treatment for a strabismus?
- prescription glasses w/ and w/out prism
- miotic drops
- patching
- visual training exercises
what’s the surgical treatment for a strabismus?
repositioning or shortening
refer patients with strabismus to…
ophthalmologist
definition of impetigo
contagious superficial bacterial infection
primary impetigo vs secondary impetigo
Primary = direct bacterial invasion of nl skin
Secondary = infection at site w/previous mild trauma
who gets impetigo?
kids 2-5 y/o (M/C)
worse in summer (warm and humid conditions)
spread easily to close contacts
how contagious is impetigo?
VERY CONTAGIOUS
what causes impetigo?
Staph aureus
what are the 3 types of impetigo?
(1) Non-bullous
(2) Bullous
(3) Ecthyma
what’s the most common type of impetigo?
Non-bullous
how does Non-bullous Impetigo present?
papule-vesicles surrounded by erythematous pustules that break and become thick adherent crust with GOLDEN “HONEY COLORED” appearance
where is Non-Bullous Impetigo usually on the body?
face and extremities
how does Bullous Impetigo present?
vesicles enlarge to form flaccid bullae w/clear yellow fluid that then rupture to form thin BROWN CRUST
where is Bullous Impetigo usually on the body?
trunk
how does Ecthyma Impetigo present?
Ulcerative form of impetigo
Lesions extend thru epidermis into deep dermis
Causes “PUNCHED OUT” ULCERS COVERED WITH YELLOW CRUST
dx of Impetigo
clinical -> TREAT EMPIRICALLY
culture fluid or base of lesion if tx fails
what are you treating in Impetigo?
Staph Aureus and Strep A
2 types of tx for Impetigo?
topical and oral tx’s
what is the topical tx of Impetigo and when is it used?
Mupirocin (bactroban)
use if simple impetigo - limited number of lesions
what are the oral tx’s of Impetigo and when are they used?
- Diclox
- Cephalexin
- Clindamycin (tastes bad so may not use)
- Bactrim if MRSA suspected
Use if bullae, multiple lesions
what are pinworms caused by?
Enterobius Vermicularis
pinworms aka eterobiasis
pinworms inhabit the…
cecum, appendix, ileum, ascending colon
LOWER INTESTINAL INFECTION
how do pinworms spread?
fecal oral route b/c so itchy
who are the ONLY known hosts of pinworms?
humans
what are s/s of pinworms?
nocturnal perianal and perineal itching
visible worms around anus and on butt
how do you dx of pinworms?
hx of the nocturnal itching or early morning itching
what is the tx for pinworms?
Albendazole (Albenga)
- single tx
- 400mg once (all ages) and repeat in 2 weeks
Can also use: Pyrantel Pamoate -> OTC and cheap!!!
what is erythema infectiousum (fifth disease) caused by?
Parvovirus B19
what’s important about the transmission of fifth disease? when does transmission stop?
unknown transmission
high transmission rates w/in households
rate of transmission stops after symptoms develop; no transmission after rash (rash not contagious)
symptoms of fifth disease (Day 1-2, Day 2-5)
Day 1-2: fever, HA, nausea, diarrhea
Day 2-5: RASH (slapped cheeks, reticulated (Lacey) rash on trunks/extremities
symptoms of fifth disease may repeat with…
sunlight, heat changes, exercise, stress
symptoms of fifth disease may linger…
weeks to months (NOT DANGEROUS)
what’s the tx of fifth disease?
supportive -> TREAT THE FEVER
what else can Parvovirus B19 cause that is dangerous?
Fetal hydrops - fetal demise
Ask mom if she should be pregnant b/c then want mom to stay away from kid with fifth disease
infectious mononucleosis is in what viral family?
EBV - widely disseminated herpesvirus
when is mono usually acquired?
in childhood as a subclinical and undiagnosed entity
what are the 3 reasons there may be a negative test for mono?
(1) did mono test too soon
(2) don’t have mono
(3) not every test is positive (high rate of false negatives)
mono is a ___ dx
clinical dx
mono virus shed is what secretions?
salivary secretions
is mono virus transmitted breast milk?
NO!! but it is found there
what’s the incubation period of mono?
4-7 weeks
as incubating, becoming contagious to those around you
what are clinical manifestations of mono?
- Fever
- Pharyngitis (pharyngeal erythema, exudates, petechiae)
- ***Posterior Cervical Adenopathy
- ***Early atypical lymphocytosis in blood work
-Splenomegaly
what’s mono associated with?
strep -> give penicillin/amox for strep and patient gets maculopapular, urticarial, petechial rash
mono is making the patient more susceptible to the amox rash
what is something you less commonly see with mono?
splenic rupture - post-trauma
how do you dx mono?
clinical dx
atypical lymphocytes >10% on diff (indicative but NOT pathognomonic)
Heterophile Ab = Monospot (horse RBC agglutination)
if patient has symptoms and findings c/w mono and the monospot is negative after retesting 1 week later, what should you consider doing?
EBV panel (EBV IgM and IgG VCA and EBNA)
what’s the tx of mono?
Supportive
-maintain hydration, antipyretics
Steroid if airway compromised by tonsillar hypertrophy
***REST!!!
patients with mono must take what precautions?
Splenic Rupture Precautions
- 3 weeks mild activity
- minimum 4 weeks for contact/high risk sports and activities
is there antiviral tx indicated for mono?
NO!!! NO ANTIVIRAL TX INDICATION
what is measles aka?
rubeola
what are sx’s of measles?
fever, cough, coryza, conjunctivitis
KOPLIK SPOTS (white spots on buccal mucosa) then maculopapular rash (14 days post exposure) -> head to toe
what is PATHOGNOMONIC for measles?
Koplik spots
when is measles contagious?
4 days before through 4 days after rash
what is measles caused by?
double stranded RNA virus (morbillivirus), thus rash is “morbilliform”
what are common complications of measles?
OM, pneumonia, croup, diarrhea
what are less common complications of measles but are more serious?
encephalitis (permanent damage), respiratory or neuro complications causing death, sclerosis panencephalitis
how contagious is measles?
VERY CONTAGIOUS
how is measles transmitted?
direct contacts with droplets or airborne
can remain on surfaces up to 2 hours
what are labs for measles?
Measles IgM antibody, measles RNA by PCR
-serum and NP swab (or urine)
what’s the measles post-exposure ppx?
MMR vaccine w/in72 hrs of exposure or IG if administered w/in 6 days of exposure
measles is a ___ illness
reportable illness
what’s the treatment for measles? why is this the treatment?
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
German Measles aka
Rubella
what causes German Measles?
virus
what are symptoms of German Measles?
rash and low grade fever with sx’s lasting 2-3 days
doesn’t make you as sick as rubeola
if pregnant, then what screening do you need?
rubella screening b/c can cause fetal demise
complications of rubella?
birth defects in pregnant woman
what is roseola?
exanthema subitum = sudden rash
what causes roseola?
HHV-6 and HHV-7 (human herpes virus)
how can roseola be transmitted?
vertically
what are s/s of roseola?
sudden high fever (102-104) -> fever subsides -> rash appears
rash trunk to arms and legs
rash is aysmptomatic
is there a test for roseola?
no!!!
if a child has a fever >5 days w/out a clear source, what do you need to think about?
Kawasaki’s Disease
Kawasaki’s disease aka…
Mucocutaneous Lymph Node Syndrome
what is Kawasaki’s disease?
Widespread inflammation of medium sized blood vessels throughout the body
it’s a VASCULITIS
what vessels does Kawasaki’s disease most importantly affect? this causes what?
coronary arteries -> causes coronary arteritis which can cause coronary artery aneurysms
what is the M/C childhood vasculitis?
Kawasaki’s disease
what ages is Kawasaki’s Disease seen in?
1-5 y/o
etiology of Kawasaki’s Disease?
unknown
-maybe infectious or genetic b/c seen in asian and Pacific Islanders
Kawasaki’s Disease Pathogenesis
Neutrophilic infiltrate observed in medium vessel walls
-causes edema in the vessels
what are Kawasaki’s Disease clinical manifestations?
fever >5 days over 100.5, bulbar conjunctivitis, mucositis, rash, extremity changes, lymphadenopathy, CV findings (chest pain, tachy)
is there a test for Kawasaki’s Disease?
NO!!!
what’s the conjunctivitis like in KD?
non-exudative, bilateral, spares the limbus
bulbar conjunctivitis
what’s the mucositis like in KD?
cracked red lips, strawberry tongue
what’s the rash like in KD?
polymorphous
begins perineal with erythema and then peels (desquamations)
then may be macular/morbilliform/targetoid
what are the extremity changes in KD?
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
what are Beau’s lines in KD?
linear nail creases (not pathognomonic for KD)
what’s the lymphadenopathy like in KD
single in neck
large >1.5 cm in diameter
what is the biggest risk of KD?
cardiovascular problems
Day 5-10: tachycardia out of proportion to fever
muffled heart sounds, brachial aneurysms
what are later CV complications of KD?
Coronary artery aneurysm, MI, arrhythmias
how do you dx KD?
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
each patient with KD dx will have what imaging done?
cardiac echo to detect CA aneurysms
also will have repeat in 4-6 weeks to document resolution
tx for KD
admit all patients for inpatient monitoring, specifically for CV fxn
IVIG = hallmark of tx
Aspirin (ASA) = hallmark of tx
cardiology consult
what tx of KD dramatically decreases risk of CA aneurysm?
IVIG
kid with KD must have what consult at dx?
cardiology consult at dx
what can pt with KD that’s treated with IVIG not have for 11 months?
live virus vaccines d/t passive immunity
if coronary artery disease from KD with dilatation <8mm, what’s the risk of morbidity? what about >8mm?
<8mm -> morbidity is low
> 8mm -> morbidity is high
what is coxsackie disease?
hand, foot, and mouth disease
what is coxsackie disease caused by? transmission?
enterovirus
transmitted by fecal-oral
what is the MOST LIKELY presentation of Coxsackie disease?
Apthous stomatitis (sores in mouth)
Rash on hands and feet
Fever
tx of Coxsackie disease?
symptomatic - Tylenol or motrin, magic mouthwash for sores
what is the classic presentation of chicken pox? stages of vesicles?
dew drop on rose petal
multiple stages of vesicles:
vesicles -> open lesions -> scabs (once scabs not contagious anymore)
tx for chicken pox?
symptomatic - motrin/tylenol for fever, Benadryl or aveeno for itch
if high risk pt, may give acyclovir, calcyclovir
complications of chicken pox?
RARE:
-encephlitis, pneumonia, bronchitis (b/c these lesions are also on organs as well as skin)
where does the varicella (VZV) virus lie?
latent in dorsal root ganglia and trigeminal nerve
what is enuresis?
involuntary urination
what is nocturnal enuresis?
bedwetting
med tx of nocturnal enuresis?
nasal spray DDAVP (vasopressin) -> increase ADH -> decrease in urine output
non-med tx of nocturnal enuresis?
moisture alarms, scheduled voiding (go pee before bed), decrease bladder stimulants like caffeine, limit fluid intake before bed
causes of UTIs in infants? need what specimen? caused by what bacteria? how do you treat and work up?
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
causes of UTIs in teens? caused by what bacteria?
STI or sexually related until proven otherwise
caused by E. coli ports (won’t show on culture)
