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54 Cards in this Set

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Caput Succedaneum
Cause and etiology?
Treatment?
a very common, benign problem of the head of the newborn which involves an area of diffuse subcutaneous edema of the presenting part of delivery
Etiology caused by pressure on the presenting part of the head during labor and delivery
Treatment-Self limiting
Caput Succedanem
S&S
DDx
Extends across the suture line
Signs and Symptoms
Swelling of the scalp apparent immediately after birth
Differential Diagnoses
Head trauma
Cephalohematoma
Child abuse
Cephalohematoma
When does it come up?
S&S
Treatment?
S&S Usually not apparent at birth
Appears during 1st day of life;  over several days
Reabsorbed over 2-3 months
Can precipitate hyperbilirubinemia
occasionally associated with an underlying linear skull fracture
Cephalohematoma
DDx
Differential Diagnoses
Caput succedaneum
Skull fracture
Cranial meningocele (pulsates)
Microencephaly
Primary vs Secondary?
What is the classification
-head circumference 2-3 SD or more below the mean for age and sex
-relatively common, especially among mentally retarded population
-two types: primary (genetic) and secondary (nongenetic) usually severe in the first 2 years of life
Microencephaly
S&S
chest circumference > head circumference in infants up to six months
-may be marked backward slope of forehead
narrowing of temporal diameter and occipital flattening (familial)
disproportionately large ears may be present
skull asymmetry can be seen with chromosomal disorderssmall anterior fontanel
Microencephaly
Diagnostics &
DDx
Diagnostics:
CT or MRI for structural abnormalities
Measure head circumference of parents/siblings
Differentials:
craniosynostosis
TORCH
screening for TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes simplex) titers in mother and child
Management of Microencephaly?
Supportive genetic and family counseling
Educational placement to maximize developmental potential
Macroencephaly
Definition and Management?
head circumference ≥ 3 standard deviations above mean for age and sex, or one that increases too rapidly
Management:
Keep close watch on weight, height, head circumference
Early neurosurgical referral is needed if suspected
Earliest signs of ICP increase
Earliest sign of ICP is a bulging or tenseness of the anterior fontanel associated with irritability, change in eating pattern, lethargy
2 types of hydrocephalus
Noncommunicating
Aqueductal stenosis (neural tube defect, neurofibromatosis)
Intrauterine infections
Lesions or malformations of posterior fosa
Neonatal meningitis or subarachnoid hemorrhage
Communicating
Allows a subarachnoid hemorrhage
Pneumococcal or tuberulous meningitis
Intrauterine infection that destroy the CSF pathways
Leukemic infiltrates
S & S of hydrocephalus
Enlarged, bulging, open AF
Dilated scalp veins
Brisk DTR’s, spasiticity, clonus, + Babinski
Irritability, lethargy, poor appetite,
vomiting, headache
Macewen Sign “cracked pot” open sutures
DDX and Management of hydrocephalus?
Differential Diagnosis
2ndary enlargement of head due to chronic anemia, metabolic and degenerative
disorders of CNS, osteogenesis imperfecta
Most of these children will have shunts. You will refer these children for treatment.
Management
NP will be responsible to maintain infant/child
Watch for signs infection of shunt
Dacryostenosis
Etiology?
S&S?
Etiology:
incomplete canalization of naso lacrimal duct
following trauma or chronic conjunctivitis
-Signs and Symptoms:tearing, accumulation of mucoid/ mucopurulent discharge and crusting
May have associated fever and irritability
Dacryostenosis DDX
Differential Diagnosis:
Conjunctivitis
Corneal abrasion
Glaucoma
Intraocular inflammation
Mucocele
Mucocele
bluish subcutaneous mass below the medial canthal tendon- it is an unusual presentation of obstructed lacrimal sac
Management of Dacryostenosis?
Management:
Massage lacrimal duct several times/day
Cleanse lids with warm water
90% will clear spontaneously by 12 months
If present >12 months refer
Offer reassurance to parents
Educate parents how to massage and clean eye
Hordeolum-
Etiology (bug)
What is it?
Complications?
Acute or subacute infection of sebaceous glands of eyelid
Internal hordeolum→ meibomian glands
Abscess is large and may point through skin or conjunctival surface
External hordeolum (stye) involve glands of eyelid
Smaller and more superficial
Points at the lid margin
Occur frequently in children
Orbital cellulitis >5 years
Perioribital cellulitis < 5years
Etiology:Staph aureus
S&S of Hordeolum
Erythema, redness of eyelid
Red, swollen tender pustules on lower lid margin
Local redness of lid margin
Risk Factors for Hordeolum

DDX
Immunologic defect
No Hib vaccine
Diabetes
Allergies, Recent URI
Trauma to eyelid
Impetigo of eyelid
Sinusitis
Differential Diagnosis:
Chalazion
Orbital cellulitis
Pyogenic granuloma
Sebaceous cell carcinoma
Management of Hordeolum
Management
May use topical ophthalmic antibiotic gtts or 0.5% erythromycin ointment tid/qid until 2-3 days after resolution
Educate patient:
Frequent, warm, moist, compresses, Avoid squeezing
Good hand washing
Referral
chalazion
Def
Etiology
S&S
Definition/Incidence
Chronic, sterile inflammation of eyelid
Deeper in eyelid tissue than “stye”
Etiology-Results from obstruction of the meibomian gland duct
Secondary infection of surrounding tissue may occur
-Signs and Symptoms-Hard, non-tender nodule usually found in the mid-portion of the eyelid
Large chalazion may press on globe causing astigmatism and distortion of vision
Painful swelling of entire lid may result from infected chalazion
What thing can a chalazion cause?
can distort vision by causing astigmatism as a result of pressure on the orbit
Management of a Chalazion
Management
May resolve spontaneously if small
If large, recurrent, or secondarily infected treat with local antibacterial gtts/ointments for 7 days
Surgical removal may be indicated if large or cosmetically disfiguring
Bleharitis
Etiology
Incidence
Types (causes of both types)
Definition/Incidence
Inflammation of the lid margins
Commonly bilateral
Recurrent or chronic

2 main types:
Seborrheic dermatitis (simple squamous type)
Ulcerative blepharitis
Non-ulcerative type usually caused by contaminated makeup or contact lens solution, poor hygiene, seborrheic dermatitis of scalp
Ulcerative type usually caused by s. aureus
Management of Blephartis
Management
Scrub lid at bath time with a no tears type shampoo
Warm compresses BID 5-10 minutes
If scalp involved must treat
Anti-staphylococcal antibiotic ointment
No rubbing of eyes
No make-up
See child back in 4 days/ or sooner if no improvement
Refer if no improvement
Etiology of Red Eye
Etiology:
C. Trachomatis infection occurs 3-8/1000 live births
Herpes Simplex occurs 1/3000-1/20,000
Bacterial infection cause 50% of conjunctivitis
Adenoviruses most common cause viral conjunctivitis
Ophthalmia Neonatorum for Herpes?
What about it?
Herpes Simplex
Seen 3days-3weeks after birth
Mother will have a hx
Can cause blindness
Mild conjunctivitis, erythema, corneal opacity serosanguinous d/c, vesicular rash on eyelids
Mainly unilateral
Ophthalmia Neonatorum
Clinical Findings
Clinical Findings:
Erythema
Chemosis
Purulent exudates with GC
Clear to mucoid exudate with chlamydia
Ophthalmia Neonatorum
Labs for Diagnosis?

GC causes?
Chlamydia causes?
Labs:
Culture
ELISA, PCR
Gram stain, R/O GC, Chlamydia

Chlamydia causes pneumonia
GC causes blindness
Management Ophthalmia Neonatorum (Chemical)
Management:
Chemical conjunctivitis
No treatment
Parents may irrigate with salt water
Need to educate parents on cause and that it should disappear in 24-36 hours
Recheck 3 days or sooner if no improvement
Ophthalmia Neonatorum with G/C
What is the management?
Gonococcal Conjunctivitis
May be admitted to hospital to check for disseminated infection
-Refer to experienced MD
Ceftriaxone 25-50 mg/kg IM/IV 10-14 day course
Management of Ophthalmia Neonatorum (c. trachomatis)
C. trachomatis
Erythromycin by mouth
Saline irrigations to eyes until discharge gone
Parents/partners need treated
Can lead to pneumonia during 1st 6 weeks life
Watch for development of cough
Treatment is 80% effective Child may need another course
Follow up in 3 days to monitor eye/sooner if parents concerned
Mangement of Ophthalmia Neonatorum with HSV
Child referral to ophthalmologist
Bacterial Conjunctivis?
bugs/causes
for newborns when does it occur
Bacterial
Occurs from 5-14 days of life newborns
-Caused by H. Flu, S. aureus, S. pneumoniae, and enterococci
S&S for Conjunctivis
Signs and symptoms:
Manifested mild /moderate mucopurulent discharge
Conjunctival injection
Redness, chemosis
Itching, burning
Increase matter in eyes
Chemosis
What is it and when is it seen most?
Chemosis an inflammatory collection of fluid under the membrane covering the white of the eye so that it swells. It indicates conjunctivitis, often of allergic origin.
Seen more in winter.
Bacterial Conjunctivis
Treatment?
Bacterial
Antibiotic eye medications
Neonates: Erythromycin 0.5% eye ointment
>1 old fluoroquinolones 4th generation or amoxicillin or augmentin if concurrent AOM
-Warm soaks
No sharing towels, wash cloths etc.
No school until treatment begins
Nonneonatal Conjunctivitis Pathogens?
Adenovirus
Herpes simplex
Herpes Zoster
Enterovirus
Molluscum contagiosum
Varicella virus
What are the S&S of Viral Nonneonatal Conjunctivitis
Clinical Findings: tearing and profuse watery d/c (key)
Fever, headache, anorexia, malaise, upper respiratory symptoms-pharyngitis, conjunctivitis, fever (key)
Management of Management:
Nonneonatal Conjunctivitis.
Management:
Good hygiene: A MUST
Self limited and usually resolves in 7-14 days
Warm or cold compresses/artificial tears
Antibiotics are not recommended
If molluscum on eyelid margins?
refer
what are the four types of allergic conjunctivitis
Hay-fever associated-mild injection and swelling
Vernal-common in 3-12 years increased prevalence in warm weather
Atopic keratoconjunctivitis-affects lower tarsal conjunctiva and is noted for severe itching, burning, and tearing. Mostly seen in adolescents

Giant papillary conjunctivitis-often in contact wearers who are allergic to thimersal in contact lens solution
Cobblestoning appearance of conjunctiva in what disorder?

What test do they do for conjunctivitis
Conjuntivitis

Eosinophils On Wright’s stain of nasal and conjunctival smears
Treatment/Prevention of Conjunctivitis
Prevention:
AVOID ALLERGENS
Cold compresses
Saline solution or artificial tears
Topical decongestants
Oral antihistamines
Topical mast cell stabilizers
Nonneonatal Conjunctivitis Treatment/Prevention
Allergic conjunctivitis
Try and avoid allergen
Cool compresses
Topical antihistamine, mast cell stabilizer or combination eye drops such as Patanol $$$$
Periorbital Cellulitis
Secondary 2?
Bacterial bugs
Occurs with infected?
Seen in children up to 6
Occur with infected lacerations, abrasions, impetigo or FBs
2ndary to paranasal sinusitis
Strep, staph aureus, moxarella catarrhalis (less than 4)
S&S of periorbital cellulitis
Fever
Inflammation and swelling of eyelids
Deep red color of eye
Deep purple H. Flu
Labs/diagnostics for periorbital cellulitis based on severitiy?
Labs: Depending on severity
CBC
Bld cultures
Lumbar punctures in < 1 year
CT
Visual acuity
EOMs, pupillary testing
DDx for periorbital cellulitis
Conjunctivitis
Cavernous sinus thrombosis
Proptosis, limited EOMs, decreased visual acuity
<1: dacrocystitis, conjunctivitis, ruptured dacrosystocele
Management of periorbital cellulitis?
Outpatient: on case by case basis
Ceftriaxone (50-75 mg/kg [up to 1 gm] IM every 12 hours
child monitored until bld cultures are negative for 48 hours or clinical improvement is seen
Then may switch to oral meds to complete 7-14 day course
Out patient periorbital cellulitis drug of choice
Amoxicillin, augmentin, and cefixime are first line choices
Warm soaks,
Periorbital Cellulitis must be inpatient if?
Hospitalization required:
Moderate to severe cases of cellulitis
Poor response to outpatient management
Purulent wound near eye
Suspect sepsis
Children less than a year