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237 Cards in this Set
- Front
- Back
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Sleep in toddlers |
10-12 hours per night with daily naps Rituals and consistency at bedtime Nightmares begin around age 3 Night terrors occur between 2&6 and most outgrow as they get older |
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Toilet training |
begins at 1.5 - 2.5 years when psychological and physiologic readiness
average daytime control typically by 2
nighttime control lags behind day by one year
do not start in times of stress
do not punish and reward all good efforts
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Developmental warning signs in toddler and pre-school |
1 year: not imitating sound not pulling to stand not indicating desires by point/gesture
18 months: doesn't make eye contact does not feed self with spoon
2 years: Not walking up the stairs not using 2-3 word phrases not noticing cars, animals not initiating self-stimulation behaviors
3 years: not aware of external environment cannot ride tricycle does not follow simple direction continues baby talk does not imitate adult activities
4 years: does not listen to a story does not speak in sentences engages in head banging or rocking is not toilet trained does not draw a human figure
5 years: magical thinking is still a dominant presence there is no impulse control
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Stuttering |
May be familial Can last for several weeks to 6 months Often resolves without intervention
Refer if: lasts > 6 months child > 6 years child avoids speaking |
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Pervasive Development Disorders (PDD) |
Autism: Marked abnormal or impaired development in social interaction and usually noted in the first year of life greatly restrictive of activities and interests may exhibit language delay
Asperger's syndrome: severe and sustained social interaction impair development of restrictive, repetitive behaviors OCD tendencies no language delay
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Rett's disorder |
It is a PDD
ONLY in females Regression following the first five months of age CNS irritability with withdrawal symptoms loss of skills that were previously mastered stereotypic hand movements delayed head growth seizures scoliosis hypertonicity |
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Childhood Disintegrative Disorder (CDD) |
Marked regression in multiple areas of functioning following at least 2 years of apparently normal development |
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When to check PPD |
once before starting school t 4-6 years old
Annually if any of the following risks: low socioeconomic status residence in areas where TB is prevalent exposure to TB Immigrant status |
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Cholesterol and Hematocrit in school-aged kids |
Hematocrit once at 8 years old and additionally if needed
Cholesterol if family hx of dyslipidemia or premature cardiac disease in parents or grandparents with a cardiac event like an MI prior to the age of 55 |
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Growth in school aged kids |
Average 10 year old is 70 pounds Average 10 year old is 52-56 inches tall
Gain 5-7 pds/year Gain 2-3 inches/year
Girls reach peak hight velocity around 11-12 prior to menarche
BMI between 85% and 95% risk for overweight
BMI over 95% indicates obesity |
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Vital signs in school aged kids |
pulse and respiration decrease blood pressure increases
Visual acuity approaches 20/20
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Developmental Guidance in school aged |
consistency adults must be a role model assigned regular duties/chores as language skills are developed, encourage parent to listen/respond
Expect lying and confront child in positive way |
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Injury prevention in school aged |
communicate about: cigarettes drugs alcohol abuse |
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Sleep in school aged |
8-10 hours per night nightmares decresased |
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Developmental warning signs in school aged |
Younger: poor adjustment to school not working to ability frequent illness/need to stay home from school lack of social interaction/peer problems
Older: revert to dependent, shy, passive using illness to avoid responsibilities cannot make or keep friends poor school performance (feels "left behind) disinterest in any extra academic activity destructive behavior to express self |
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ADHD |
symptoms must be present before age 7 symptoms must persist for at least 6 months symptoms must be more frequent and severe than those observed in other children at the same developmental level
symptoms must interfere with at least 2: home school
s/s must be at least 6 inattention symptoms or 6 hyperactivity/impulsivity symptoms play |
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Inattention in ADHD |
makes careless mistakes fails to pay attention to detail easily distracted difficulty concentrating long enough to complete task difficulties following instruction difficulties organizing task and activities |
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Impulsivity in ADHD |
difficulties awaiting one's turn frequently blurts out answers interrupts or intrudes on others |
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Hyperactivity in ADHD |
fidgetiness difficulty remaining seated difficulty playing quietly subjective feelings of restlessness in adolescent difficulty with social relationships low frustration tolerance |
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Management ADHD |
structured environment consider mental health referral
Meds: Methylphenidates (ritalin, concerta, metadate, focalin) Amphetamines (adderall, adderall XR, dexedrine, vyvanse) |
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Prescribing principles with ADHD meds |
Start low and Go slow!
behavior changes can be noted within 30-90 minutes of ingestion
short acting last 4 hours
Do not chew!
If child doesn't respond to higher doses of one stimulant, or if side effects are unacceptable, switch stimulants before changing meds completely
long acting last 10-12 hours
PRACTICE DRUG HOLIDAYS |
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Definition of Adolescense |
12 through 20 years of age
Early adolescence: 12-14 Middle adolescence: 15-17 Late adolescence: 18-20 |
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When do PAP smears begin |
if pelvic exam is performed, at age 21 or 3 years after becoming sexually active |
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HEADS format for adolescent interview |
Home environment Employment and education Activities Drugs Socially Sexuality |
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PACES format for adolescent interview |
Parents, peers Accident, alcohol/drugs Cigarettes Emotional issues School; sexuality |
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SAFETEENS format for adolescent interview |
Sexuality Accident, abuse Firearms, homicide Emotions (suicide/depression) Toxins (tobacco/alcohol, others) Environment (school, home, friends) Exercise Nutrition Shots |
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Tanner stage boys |
1. preadolescent testes, scrotum, penis 2. enlargement of scrotum and testes; scrotum roughens and reddens 3. penis elongates 4. penis enlarges in breadth and development of glans; rugae appear 5. adult shape and appearance |
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Tanner stage girls |
1. preadolescent breasts 2. breast buds with areolar enlargement 3. breast enlargement without nipple separate nipple contour 4. areola and nipple project as secondary mound 5. adult breast: areola recedes, nipple retracts |
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Pubic hair males and females (tanner stages) |
1. preadolescent 2. sparse, pale, fine 3. darker increased amount, curlier 4. adult in character but not as voluminous 5. adult pattern |
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Female menarche |
between breast development in tanner stages 3-4 and predominantly at 4 |
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Nocturnal emissions |
shortly after tanner stage 3 |
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Precocious puberty |
onset of puberty before age 8 in girls onset of puberty before age 9 in boys |
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Who is primary influence in adolescents |
parents |
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Preventative health issues in adolescents |
mental health (depression and/or suicide) gang activity |
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Developmental warning signs in adolescents |
change in school performance change in friendships change in eating or sleeping habits apparent personality changes difficulty accepting failure talk of suicide withdraw from friends or family |
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Anorexia nervosa |
eating disturbances, refusing to eat, weight loss
amenorrhea ensues
peak incidence is 14-18 |
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Bulemia nervosa |
episodic binge and purge episodes
peak incidence 14-18
tooth enamel erosion |
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Blood flow of the heart |
Tissue Paper My Assets
Superior vena cava right atrium Tricuspid right ventricle Pulmonic pulmonary artery lungs pulmonary veins left atrium Mitral valve left ventricle Aortic aorta body |
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What is happening in S1 |
mitral/tricuspid (AV) valves are closed |
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What is happening in S2 |
Aortic/pulmonic (semilunar) valves are closed |
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What is systole |
period between S1 and S2
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What is diastole |
period between S2 and S1 |
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What is S3 |
"kentucky" sound CHF normal finding in pregnancy because of fluid overload |
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What is S4 |
"tennesse" sound due to stiff ventricular wall
HTN MI |
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Where to hear aortic |
RUSB |
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Where to hear pulmonic |
LUSB |
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Aortic or mitral is heard? |
Apex |
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Ventricular septal defect or tricuspid is heard? |
LLSB |
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How are murmurs graded? |
I-VI
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Acyanotic lesions |
left to right shunting and without cyanosis |
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Cyanotic lesions |
right to left shunting they bypass the lungs so cause cyanosis |
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Atrial septal defect (ASD) |
Grade II to III/VI systolic ejection murmur LUSB RVH Cardiomegaly Increased pulmonary vascular markings |
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Ventricular Septal Defect (VSD) |
Grade II to V/VI systolic ejection murmur Holosystolic thrill might be felt at LLSB LVH progressing to biventricular if large Cardiomegaly Increased pulmonary vascular markings |
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Patent ductus arteriosis (PDA) |
Very common in premature infants
Murmur: LUSB Grade II to IV/VI and holosystolic Machinery sound LVH to biventricular Cardiomegaly increased pulmonary vascular findings |
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When does the ductus areteriosis close? |
48 hours to 2 weeks after birth
Can give prostoglandins to keep it open if needed |
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Transposition of the Great Arteries |
Holosystolic murmur heard in LLSB RVH
"egg on a string" in XRay cardiomegaly increased pulmonary markings |
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Tetralogy of Fallot |
Four defects: large VSD pulmonary stenosis overriding aorta RVH
Murmur: loud systolic ejection click at mid LUSB
Right axis deviation and RVH
Boot-shaped heart on xray
NO cardiomegaly NO increased pulmonary markings
Have Tet spells…squat to slow breathing Knee chest position to sleep to help breath |
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Aortic stenosis |
systolic thrill at RUSB systolic ejection click that doesn't vary with respirations Grade II to IV/VI murmur LVH normal xray |
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Pulmonic stenosis |
systolic murmur that is loudest at LUSB Grade II to V/VI ejection click with thrill
Intensity of click decreases with inspiration and increases with expiration
thrill at LUSB radiating to back and sides
RVH normal xray |
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Coarctation of the Aorta |
II to III/VI systolic ejection murmur that radiates to the left inter scapular area
RVH progressing to LVH
Cardiomegaly Pulmonary venous congestion Rib notching
BP in lower extremities with be lower than in upper |
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Common cardiac defects in genetic syndromes |
Trisomy 18 (Edwards) DiGeorge: aortic arch anomolies Down Syndrome: ASD, VSD Marfans: aortic regurge, MVP Turner: coarctation of the aorta, bicuspid aortic valve |
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Innocent murmurs |
no associated symptoms, FTT or cyanosis
systolic murmurs grade I-III/VI
may vary with position
no radiation to neck or back
Stills is most common and heard at LL border
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Venous Hum |
continuous humming murmur
RUSB
heard best in sitting position and may disappear in the supine position
obliterated by turning head and compressing neck on the same side you hear the hum |
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HTN in peds |
HA visual problems dizziness nosebleed respiratory distress irritability
check: chest xray plasma aldosterone cortisol levels UA, BMP, CBC, cholesterol and trig ECG
Refer to cardio |
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Rheumatic fever |
follows a group "A" strep infection of upper respiratory tract
most common in 6-15 year olds
S/S: (one major and two minor) Major: carditis polyarthritis chorea (worm like movement) erythema marginatum SQ nodules
Minor: arthralgia without objective inflammation Fever >102.2 Elevated ESR Prolonged PR interval on ECG with evidence of a group "A" strep infection
Perform throat culture
Refer to cardio
Will need prophylactic abx for procedures as indicated |
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Kawasaki Diseasea |
afebrile syndrome causing vasculitis
strawberry tongue fever for more than five days cervical lymphadenopathy
CBC ESR CRP ECG: prolonged QT or PR interval
Refer immediately to cardio
ASA therapy: 80-100 mg/kg/day until afebrile for 48 hrs then 3-5 mg/kg/day for platelets D/C ASA in collaboration with cardio
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Gastroenteritis in kids |
acute nausea, vomiting, and diarrhea Generally caused by virus like Rotavirus or Adenovirus
If bacterial: salmonella campylobacter (odorous stool) shigella (fever spikes, bloody stools) e.choli (mild loos stools)
S/S: n/v hyperactive bowel sounds watery diarrhea general "sick" feeling = septic anorexia abdominal cramping/distention
two negative stool cultures prior to going back to daycare
supportive care oral rehydration…mod: 50 ml/hr severe: 100 ml/hr regular diet after rehydration BRAT diet or bland foods
no anti-motility drugs
if 8-10 stools daily use abx: bactrim
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GERd in kids |
Infrequent episodic vomiting painless vomiting
choking cough wheeze weight loss irritable stool pattern changes sore throat, dental errosions recurrent vomiting
CBC UA with culture stool for occult blood ultrasound to rule out pyloric stenosis
Small frequent feeds burp frequently continue breastfeeding avoid formula changes weighted formula: 1 TBSP rice cereal per oz
Zantac, Pepcid, Prilosec
Consider GI referral |
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Pyloric Stenosis |
3-4 weeks old projectile non-bilious vomiting after eating hungry after vomiting poor weight gain or weight loss dehydration palpable mass (PYLORIC OLIVE) after vomit
US String Sign on imaging
Refer to surgeon |
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Intussusception |
Most common before age 2
Previously healthy infant develops colicky pain bilious vs non-bilious vomiting progressive lethargy currant jelly stool sausage shaped mass in RUQ
Radiography Barium enema
Surgery |
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Hirschsprung's Disease (Aganglionic Megacolon) |
Failure to pass meconium Bilious vomiting Jaundice Infrequent, explosive BM Progressive abd. distention tight anal sphincter with an empty rectum (because stool isn't passing) FTT malnutrition
Abd Xray Barium enema Rectal/colon biopsy
Refer to Gi or surgeon |
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Appendicitis
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If untreated, perforation may occur in 36 hours
Begins with vague colicky umbilicus pain After several hours, pain shifts to RLQ
+ psoas sign rebound tenderness + obtruator's sign McBurney's point sense of constipation; infrequent diarrhea pain worsens with localized cough
surgical consult pain management |
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Obtruartor sign |
pain with internal rotation of the right thigh |
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McBurney's point tenderness |
one-third the distance from the anterior iliac spine to the umbilicus |
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Psoas sign |
pain with right thigh extenstion |
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Malabsorption |
FTT severe, chronic diarrhea bulky, foul stool (steatorrhea) vomting abdominal pain protuberant abdomen
Stool culture, O&P hemocult Ca Phosphorus Alk Phosphate Ferritin Protein Folate LFT Sweat chloride if suspect CF
Treat infections Dietary modifications: celiac: no wheat, oats, rye, barley CF: pancreatic enzyme replacement…glipase, amylase, tripsen
Refer to Gastro |
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Neuroblastoma |
tumor arising from neural tissue, frequently front he adrenal gland and can spread to bone marrow, liver, lymph nodes, skin, and eye orbit
FTT Enlarged and mass profuse sweating tachy
Urine catecholamines Abdominal CT biopsy
refer to ped. oncologist |
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Hepatitis |
inflammation of the liver resulting in liver dysfunction
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Hep A |
oral-fecal route contaminated water or food symptoms manifest 2-6 weeks after infecton |
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Hep B |
blood-borne saliva semen vaginal secretions all body fluids
transmitted mother to fetus
incubation 6 weeks to 6 months |
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Hep C |
blood transfusion IV drug use maternal-neonatal transmission is rare Incubation 4-12 weeks |
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hepatitis S/S |
pre-icteric: fatigue, malaise, anorexia, n/v, HA…foods that were sweet taste salty and foods that were salty taste sweet
Icteric: weight loss, jaundice, pruritis, RUQ pain , clay colored stool, dark urine
low grade fever hepatosplenomegaly tenderness over liver dark urine light stool |
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Lab for Hepatitis |
CBC UA AST will be elevated LDH, bilirubin, alk phosphate, and PTT will be normal or slightly elevated |
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Management of Hepatitis |
generally supportive: rest during active phase
increase fluids to 3000-4000 ml/day
vitamin K for prolonged PT (>15 sec)
avoid alcohol and meds detoxed by the liver
little to no protein
lactulose if ammonia levels due to encephalopathy |
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Serology for Active Hep A |
Anti-HAV, IgM
IgM (means it's immediate…it's now)
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Serology for Recovered Hep A |
Anti-HAV, IgG |
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Serology for Active Hep B |
HBsAg, HBeAg, Anti-HBc, IgM |
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Serology for chronic Hep B |
HBsAg, Anit- HBc, Anti-Hbe, IgM, IgG |
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Serology for recovered Hep B |
Anti-HBc, Anti-HBsAg |
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Serology for acute Hep C |
Anit-HCV, HCV RNA |
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Chronic Hep C |
Anti-HCV, HCV RNA |
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Mild Dehydration |
3% to 5%
BP normal Pulse/Heart rate normal CAP refill WNL Skin turgor normal Fontanel normal Urine slightly decreased
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Moderate dehydration |
6% to 9%
BP normal Pulse/heart rate increased CAP refill WNL Skin turgor decreased Fontanel slightly sunken Urine <1ml/kg/hour |
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Severe dehydration |
>10% BP normal, decreased Pulse/heart rate severe, decreased CAP refill prolonged (>3 seconds) Skin turgor decreased Fontanel sunken Urine <1ml/kg/hour |
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If an 8 month old is only wetting 2-3 diapers/day, this could mean? |
dehydration |
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Burns |
First degree: dry, red, no blisters, only epidermis
Second degree (partial thickness): moist, blisters, extends beyond epidermis
Third degree (full thickness): dry, leathery, black, pearly, waxy; extends from epidermis to dermis and underlying tissues…fat, muscle and/or bone |
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Primary management of burns in kids |
Assess ABCs Prophylactic intubation if: singed nares or eyebrows evaluate nares/mouth for soot/mucous
Drench the burn with cool water Do not cover with lotion, toothpaste, butter, etc First six hours are critical
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Macule |
flat discoloration |
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Patch |
flat discoloration that looks as though it is a collection of multiple, tiny pigment changes
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Papule |
small elevated, firm lesion < 1cm |
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Nodule |
an elevated firm lesion >1cm |
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Tumor |
firm elevated lump |
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Wheal |
lesion raised above the surface and extending a bit below the epidermis
like a PPD wheal |
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Plaque |
scaly elevated lesion
classic with psoriasis |
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Bulla |
serous fluid-filled vesicles >1 cm |
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Pustule |
small pus-filled lesion <1 cm |
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Abscess |
pus filled lesion >1 cm |
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Cyst |
large, raised lesions filled with serous fluid, blood, and puss |
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Primary lesions in skin disorders |
firs appearing |
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Secondary lesions in skin disorders |
follows primary lesions |
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Solitary or discrete |
individual or distinct lesions that remain separate |
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Grouped |
linear cluster |
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Confluent |
Lesions that run together |
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Linear |
scratch, streak, line, or stripe |
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Annular |
circular, beginning in the center and spreading to the periphery |
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Polycyclic |
annular lesions merge |
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S/S Acne |
Comedones Open: blackheads, opening in the skin with blackened mass of skin debris
Closed: whiteheads, obstructed opening which may rupture causing a low grade inflammatory response
Depressed or hypotropic scars
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Non-pharmacologic management of acne |
Avoid topical, oil-based products
Use of oil-free, mild soaps, cleansers, and moisturizers |
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Pharmacologic management of MILD acne |
Topical benzoyl peroxide If not responsive, can used retinoic acid gel or cream…it's category C Trentinoin inactivated by UV light and oxidized by benzoyl peroxide. Use trentinoin at night and benzoyl peroxide in morning
Salicylic acid like neutrogena face wash
Topical antibiotics: ERYC or clindamycin lotions or pads |
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Pharmacologic management of MODERATE acne |
Severe pustular acne
Requires systemic antibiotics with topical
Doxy ERYC Minocycline
SEVERE acne that doesn't respond is to be referred |
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Tinea capitus |
scalp |
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Tinea corporis |
body ringworm |
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Tinea cruris |
jock itch |
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Tinea manuum and tidea pedis |
athlete's foot |
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Tinea versicolor |
hypo/hyperpicmentation macules on limbs |
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S/S of fungal infections |
may be asymptomatic (captious)
severe itching (cruris and pedis)
erythematous rings (corporis)
solitary areas of hypo pigmentation or hyper pigmentation (versicolor) |
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Lab diagnostics for fungal infections |
Spaghetti and meatball microscopically when treated with KOH |
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Primary treatment with fungal infections |
Griseofulvin |
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Primary treatment with capitus |
griseofulvin |
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Primary treatment with corporis |
topical antifungals like miconazole |
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Treatment of cruris |
topical griseofulvin in severe cases |
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Treatment of manuum and pedis |
aluminum subacetate solution to soak for 20 min BID
apply topical antifungals as described in the dry, scaly stage
oral therapy in severe cases |
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Treatment in versicolor |
selenium sulfide shampoo for 5-15 min daily for 7 days
Make sure head and shoulders is 2% |
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Chicken Pox (Varicella Zoster Virus) |
Contagious for 48 hours before outbreak and until lesions have crusted over
Most common in ages 5-10 |
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Chicken Pox S/S |
erythematous macules papules over macules vesicles erupt: usually distributes initially on the trunk then scalp and face intense pruritus low grade fever generalized lymphadenopathy |
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Chicken pox management |
prevention with vaccine Supportive care for pruritis: calamine/caladryl lotion antihistamine acetaminophen for fever
Oral acyclovir given in the first 24 hours can reduce the magnitude or duration of symptoms |
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Molluscum Contagiosum |
Pink flesh colored lesions that are benign Disappear on their own in a few weeks to months Not easily treated |
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S/S Molluscum contagiosum |
Lesions present on face, axillae, antecubital fossa, trunk, crural fascia, and extremities
itching at site of infection |
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Management of molluscum contagiosum |
resolves spontaneously if left alone
mechanical removal
currette
trentinoin cream liquid nitrogen salicylic acid daily at HS
Prevent scratching and touching lesions to stop from spreading
If extensive lesions or diagnosis is unclear, refer to derm |
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Atopic Dermatitis (Eczema) |
chronic skin condition characterized by intense itching along a typical pattern of distribution with periods of remission and exacerbation
Often worse in the winter
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S/S Eczema |
intense pruritis along face, neck, trunk, wrists, hands, antecubital and popliteal folds
dry scaly skin
Acute flare ups may show: red, shiny, or thickened skin
Inflamed and/or scabbed lesions with diffuse erythema and scaling
Dry, leathery, and lichenified skin |
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Management of eczema |
Dry skin management …. moisturizing lotion immediately following bath and blot dry
Topical steroids applied 2-4 times daily and rubbed in well: start with hydrocortisone, triamcinolone
Systemic steroids only in extreme cases
In acute weeping: saline or aluminum subacetate solution colloidal oatmeal bath |
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Allergic Contact Dermatitis |
Direct contact with chemicals or allergens
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S/S Allergic Contact Dermatitis |
redness, pruritis, scabbing tiny vesicles that are weepy, encrusted in acute scaling, erythema and thickened skin in chronic location will suggest cause hot swollen affected area history of exposure to offending site |
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Management of Allergic Contact Dermatitis |
avoid scrubbing with soap and water
high potency topical steroids locally
If severe and systemic give oral steroids |
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Irritant (Diaper) Dermatitis S/S (generally due to exposure to chemical irritants and prolonged contact with urine/feces) |
fiery red rash papules, vesicles, crusts, ulcerations infants may be irritable |
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Management of Diaper Dermatitis |
barrier emollient like zinc oxide hydrocortisone when erythematous/papules Burrow's (Domeboro) compress for severe erythema and vesicles Secondary fungal or bacterial infections treat Allow diaper area to air several times daily |
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Psoriasis |
Epidermis turn over time is 14 days to 2 days |
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Psoriasis S/S |
often asymptomatic itching may occur lesions are red, sharply defined plaques with silver scales scalp, elbows, knees, palms, soles, nails Fine pitting of nails Separation of nail plate from bed
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Auspitz's sign |
droplets of blood when scales of psoriasis are removed |
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Management for Psoriasis |
Topicals for the scalp: tar/salicylic acid shampoo medium potency topical steroid oil
Topical steroids for the skin: BID for 2-3 weeks betamethasone dipropionate triamcinolone
UVB light and coal tar exposure
Moisturizers
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Pityriasis Rosea |
more common in spring and fall
herald patch with christmas tree pattern rash on trunk and proximal extremities
If pruritic, give atarax or oral antihistamines
Cool compress, baths
Topical anipruritic like sarna lotion, cetaphil
topical steroids like triamcinolone
can do oral ERYC |
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Impetigo |
Predominantely occurs on the face but can be anywhere
Most often in the summer
Highly contagious and autoinoculable |
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Impetigo S/S |
inflammation pain, swelling, warmth CLASSIC HONEY CRUSTING LESIONS
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Treatment of Impetigo |
antimicrobials like bactroban or bacitracin
Dicloxacillin, cephalexin, ERYC, clincamycin
Abstain from school until 48 hours of treatment
Burrow's (Domeboro) solution to clean the lesions |
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Scabies |
highly contagious caused by a parasitic mite that burrows into stratum corneum |
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S/S Scabies |
intense itching irritability in infants LINEAR CURVED BURROWS
Infants: red-brown vesiculopapular lesions on head, neck, palms, or soles
Older children: red papules on skin folds, umbilicus, or abdomen |
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Management of Scabies |
Perethrin (Nix) 5% rinse….leave on for 8-14 hours…repeat in one week
Rash may persist for one week
wash all washable items
store non-washable items for one week
antihistamines for pruritus |
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Lyme Disease |
mice and deer ticks |
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S/S Stage I Lyme Disease |
erythema migrans: flat or slightly raised red lesion that expands over several days
bull's eye appearance
flu-like symptoms |
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S/S Stage II Lyme Disease |
HA Stiff joints migratory pains aseptic meningitis Bell's palsy |
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S/S Stage III Lyme Disease |
joint and periarticular pain subacute encephalopathy bluish red discoloration of the distal extremity with edema: acrodermatitis chonicum atrophican |
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Lab tests for Lyme Disease |
ELISA: detection of antibody
WESTERN BLOT: confirmatory |
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Management for Lyme Disease |
Under age 7: Amoxicillin or ceuroxime axetil
Over age 7: Doxy
Refer for stage II or III |
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Rubeola |
Ordinary measles
Highly contagious |
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S/S Rubeola |
fever runny nose cough red eyes spreading skin rash
Koplik's spots: small white spots on the inside of the cheek
Comfort measures for pain and dehydration |
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Rubella |
acute, contagious viral disease caused by RNA virus
TERATOGENIC!!!!! |
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S/S Rubella |
history of inadequate immunization fine erythematous maculopapular rash that begins on the face, spreads to the extremities and trunk rash gone in 72 hours malaise joint pain
Supportive care educate on danger to pregnancy |
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Erythema Infectiosum (Fifth Disease) |
Transmitted via respiratory droplets
Incubates 4-14 days
Not contagious after fever breaks; return to school
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S/S Fifth Disease |
"slapped cheek"
lacy reticular exanthema spreads to upper arms, legs, trunks, and dorsum hands/feet
Rash can last up to 40 days; avg. 1.5 weeks
Patient education about intrauterine infection Immunoglobulin to exposed pregnant women |
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Roseola Infantum (Sixth Disease) |
No viable treatment 6 mo-2 years
Rare after 4 years of age |
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S/S Sixth Disease |
respiratory illness high fever for up to 8 days with abrupt end possible seizures associated with fever rash of small, pink, flat, or slightly raised bumps on the trunk, then extremities |
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Coxsackie Virus (Hand-Foot-and-Mouth-Disease) |
highly contagious viral illness involving the soft palate and hands and feet
under 10 years of age
resolves spontaneously in less than a week |
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S/S Hand-Foot-and Mouth-Disease |
fever malaise vomiting drooling paulovesicular rash
Acetaminophen Topica application for comfort |
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Hordeolum (stye) |
hurts
Staph
warm compresses bacitracin or eryc ointment
refer to opthal. for possible I&D if no resolution in 48 hours |
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Chalazion |
painless
cyst
warm compresses refer for surgical removal |
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Conjunctivitis |
most common eye disorder "pink eye" from allergens, chemical irritation, or infection |
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S/S conjunctivitis |
inflammation, redness, irritation itching, burning increased tears blurred vision eyelid swelling foreign body sensation crusty/sticky eyelids |
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Management of Chemical conjunctivitis |
flush with normal saline |
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Management of bacterial conjunctivitis |
Purulent discharge
ERYC ointment Tetracycline ointment Polymyxin B |
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Management of genococcal conjunctivitis |
EMERGENCY
Copious or purulent drainage
IV PCN or Ceftriaxone |
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Management of Chlamydia conjunctivitis
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ERYC ointment
Oral: Tetracycline, ERYC, clarithromycin, azithromycin, doxy |
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Management of allergic conjunctivitis |
Stringy discharge and increase tears
Oral antihistamines refer to allergist or opthalmologist
No steroids |
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Management of Viral conjunctiviits |
watery discharge
saline, artificial tears decongestant/antihistamines, NSAIDS sulfacetamide gtts if bacterial
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Management of Herpetic conjunctivitis |
BRIGHT RED AND IRRITATED
refer to opthalmology |
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Cataracts |
white fundus reflex
refer for surgical removal |
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Strabismus |
ocular misalignment
squinting decreased visual acuity head tilt face turning
Refer to opthalmology |
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Esotropia |
eyes go inward |
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Exotropia |
eyes go outward |
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Hypertropia |
eyes go upward |
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Hypotropia |
eyes go downward |
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Otitis Externa (Swimmer's ear) |
inflammation of external auditory meatus
can be bacterial, fungal, or viral
Recent history of water exposure
Hx mechanical trauma, foreign body, excess cerumen |
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S/S Swimmer's ear |
Otalgia: Pain pruritis purulent drainage |
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Physical exam findings of swimmer's ear |
erythema of ear canal edema of ear canal purulent exudate (sometimes with odor) pain upon manipulation of auricle TM: normal
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Management of swimmer's ear |
remove purulent debris protect from moisture or injury
Topical ear medications Bacterial: acetic acid with or without hydrocortisone cortisporin (neomycin, polymyxin B)
Fungal: antifungal drops (clotrimazole) |
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Acute Otitis Media (AOM) |
Bacterial S. Pneumoniae H. Influenza
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S/S AOM |
decreased hearing otalgia fever aural pressure vertigo n/v |
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Physical exam findings of AOM |
TM: erythematous and edematous Purulent exudate TM rarely bulges |
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Management of AOM |
Acetaminophen Benzocaine otic drops
watch and wait for 48-72 hours in healthy kids
Amoxicillin
Avoid secondhand smoke
HIB, PCV13, annual flu |
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Serous Otitis Media/Otitis Media with Effusion (OME) |
fluid in the middle ear without s/s of AOM
AKA: chronic otitis media with effusion
caused by blocked eustachian tubes allergy |
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S/S OME |
hearing loss popping sensation when pressure altered fullness in the ear |
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Physical exam findings in OME |
air bubbles behind TM decreased membrane mobility Weber and Rinne tests suggestive of conductive hearing loss |
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Management of OME |
watchful monitoring for three months Re-evaluate in 3-6 months
antihistamines/decongestants are ineffective
No long term efficacy with antibiotics |
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Conductive hearing loss |
cerumen impaction hematoma otitis media perforated TM |
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Sensorinerual hearing loss |
acoustic neuroma syphilis CNS disease med toxicity |
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When using the tuning fork, which of the 3 middle ear bones touch? |
Malius |
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Weber test |
Tuning fork to the top of the head
Should be heard equally in both ears and not lateralize |
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Rinne test |
Tuning fork behind ear and then in the air behind the ear
Air conduction should be greater than bone conduction |
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Weber and Rinne findings with conductive |
Weber: sound lateralizes to affected ear Rinne: abnormal in affected ear (AC
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Weber and Rinne findings with sensorineural |
Weber: sound lateralizes to the unaffected ear Rinne: Normal in affected ear |
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Lab/Diagnostics for sensorineural and conductive hearing loss |
otoscopic exam general neuro exam CT scan if neuro condition suspected
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Management of conductive and sensorineural hearing loss |
remove foreign body/cerumen refer for audiogram refer for further evaluation/hearing aid |
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Common Cold |
viral rhinitis self-limiting URI
S/S: HA WATERY RHINORRHEA Sneezing Cough ST Malaise
Management: rest and hydration nasal saline drops humidifier No OTC cold preparations No antibiotics |
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Epistaxis (Nosebleed) |
Usually from one nostril upset stomach possible from blood dripping
Management: Sit upright Pressure at Kiesselbach's triangle x 10 min Apply ice |
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Pharyngitis/Tonsillitis |
Inflammation of pharynx or tonsils
Caused by: RSV Influenza A Epstein Barr Group A-B hemolytic streptococci Neisseria gonorrhoeae Mycoplasma Chlamydia trachomatosis
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S/S Pharyngitis/Tonsillitis |
erythematous pharynx dysphagia; cough malaise rhinorrhea (viral) fever (moreso with bacterial infections) anterior cervical adenopathy (bacterial) painful throat exudate |
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FLEA for Strep throat |
F = fever >98 L = lack of cough E = pharyngo-tonsillar exudate A = anterior cervical adenopathy |
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Lab/diagnostics for pharyngitis |
Throat culture ONLY if suspicious of strep |
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Management of Pharyngitis/tonsillitis |
supportive care rest/hydration warm salt water gargles antipyretics (tylenol) |
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Management of Strep Throat |
Penicillin VK If allergic to PCN give ERYC |
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Epiglottitis |
EMERGENCY….IMMEDIATE HOSPITALIZATION
sudden onset fever choking sensation hyperextension of the neck
strep, pneumonococci, h. influenza
NO PHARYNGEAL EXAM |
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Croup |
can be mild to severe
common in fall and winter
S/S: recent URI bark-like cough low grade fever lungs typically clear stridor if severe |
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Diagnostics in croup |
pulse ox: hypoxia in severe forms "steeple" shaped narrowing of trachea on frontal X-ray of neck |
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Management of croup |
mild: outpatient supportive care moderate: hospitalize for IV fluids
nebulized epi short course corticosteroids |
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Epiglottitis VS Croup |
Epiglottitis Bacterial Supraglottic 6-10 years of age high fever drooling x-ray: thumb sign
Croup viral larynx 3mo-6 years old low fever barky cough x-ray: steeple sign |
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Infectious Mononucleosis |
Due to the Epstein-Barr Virus
Usually occurs over the age of 10
Transmitted via saliva
One-Two months incubation time
Self-limiting but the malaise may last a few months |
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S/S Mono |
Fever Pharyngitis (most severe) Malaise anorexia myalgia |
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PE Mono |
Posterior cervical adenopathy generalized lymphadenopathy white exudate on tonsils splenomegaly maculopapular or petechial rash |
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Lab/Diagnostics for Mono |
Neutropenia Positive monospot
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Management of Mono |
supportive (non-steroidals, warm gargles) oral corticosteroids when enlarged tissue threatens airwary
Avoid contact sports 3weeks-several months to avoid splenic rupture |
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Sinusitis (Rhinosinusitis) |
9 years or older
S. pneumoniae, H. influenza, M. catarrhalis |
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S/S Sinusitis |
pain and pressure over cheek HA discolored nasal discharge halitosis post nasal drip and cough (worse at night) dull throbbing pain when head is dependent |
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Lab/Diagnostics for Sinusitis |
Usually diagnosis made off clinical presentation
With uncomplicated presentation: CT
Children under age nine have poorly differentiated sinus cavities (honeycomb) |
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Management of Sinusitis |
Uncomplicated: Amoxicillin or ERYC for 14 days Decongestants Antihistamines Pain managed with tylenol Nighttime humidification Supportive care
Chronic = refer to otolaryngologist |
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Influenza |
Types A and B
S/S: ABRUPT onset of: fever HA Myalgias Coryza (inflammation of the nose) Anorexia Malaise Cough
Lab/Diagnostics: nasal swab
Management: Supportive care: antipyretics Neuraminidase Inhibitor (shorten duration by two days and given within 48 hours of onset of symptoms) Zanamivir or Relenza (Inhaler) Oseltamivir or Tamiflu (Oral) |
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Posterior nosebleeds are usually from? |
Artery in the back of the nose
Most are from anterior septum
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How to manage nose bleed at home? |
Afrin or neo-synephrine in the nostril |
