Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
179 Cards in this Set
- Front
- Back
|
Basics of coxsackie viruses
|
Enterovirus family, types A&B, fecal oral contamination, common in 1-4 years, prevalent in summer months (May-October), Incubation 3-6 days, shed for several weeks
|
|
|
Herpangina
|
Coxsackie A
S/S: fever, vesicles on buccal mucosa, maculopapular rash on hands/feet, anorexia, vomiting, will spontaneously resolve in 1-2 weeks |
|
|
Coxsackie A illnesses
|
Acute respiratory illness: sore throat, N/V/D, coryza, pneumonia,
non-specific febrile illness: fever, myalgia, malaise, Acute lymph node enlargement with pharyngitis: acute sore throat X 1 week, Aseptic meningitis: fever, stiff neck, HA, altered senses seizure, Paralytic disease: Guillain-Barre like ascending paralysis |
|
|
Coxsackie B infection (Neonatal)
|
Vomiting, fits, cyanosis, pallor, tachycardia, serious disseminated disease, can be fatal, transplacental infection, symptoms start 2 weeks after birth
|
|
|
Coxsackie B infection (Pleurodynia)
|
Severe sudden chest pain with waves of spasms, Increased pain with cough, deep breathing, before pain—HA, malaise, anorexia, fever, lasts 1-10 days
|
|
|
Coxsackie B infection (Myocarditis/pericarditis)
|
Mild to severe heart disease, symptoms start 2 weeks after exposure
|
|
|
Hepatitis A
|
Picornavirus, RNA, primary liver infection, very contagious, fecal-oral transmission, contagious 2 weeks before to 1 week after symptoms,
Pre-icteric: fever, pain, maaliase, N/C, anorexia, RUQ pain Jaundice: dark urine/stool, sick Dx: IgG, IgM will spontaneously resolve, children often asymptomatic (adults symptomatic), HAV routine |
|
|
Measles
|
Incubation: 8-12 days before rash, contagious 3-5 days before rash and 4 days after rash
Prodromal (4-5 days): URI symptoms, fever, cough, coryza, conjuncticitis, Koplik spots (blue/white granules in the mouth) Rash (Day 3-4): increased temperature, STARTS ON EARS/FOREHEAD, rash=erythematous, maculopapular |
|
|
Rubella
|
Incubation 14-23 days, infectious 3 days before and 5-7 days after rash (generalized maculopapular rash), with POST-OCCIPITAL lymph nodes, fever, malaise, joint pain, can be asymptomatic, purpura is rare
|
|
|
Erythema infectiosum (5th disease)
|
Parvovirus B19, seen in 2-15 years,
Incubation: 4-20 days, rash appears 2-3 weeks after exposure, infectious until rash resolves Prodrome: fever, HA, myalgia (may have no prodrome) truncal LACY rash that spreads outward, “slapped cheeks,” can have periodic reoccurrences and lasts up to 7 month |
|
|
Roseola (Exanthem Subitum/6th disease)
|
Herpes 6,7, common in 6-18 months rare in children older than 3
Incubation: 9-10 days Sudden onset, high fever for 3-6 days, URI symptoms, lymph, lethargy, GI symptoms, as fever decreases—diffuse rose colored rash appears and lasts 1-13 days, rare complication: febrile seizure |
|
|
Infectious mononucleosis
|
EBV(can be CMV in younger children), transmitted by pharyngeal secretions (2-6 week incubation period), Increased size in lymphoid tissue (nodes, spleen, liver), atypical lymphocytes in the blood, increased fever for 2-3 days, sore throat, grey tonsilar exudate, skin rash
Dx: EBV serology, CMV serology |
|
|
Mumps
|
Paramyxovirus, carried in saliva, incubation is 14-24 days, infectious 1 day before swelling and 3 days after swelling resolves Prodromal: rare, fever, HA, anorexia, neck pain, malaise
|
|
|
Mumps (Swelling)
|
24 hours after prodrome, parotid swelling, discrete pink rash, salivary glands, all over swelling, “pink sign”, sour foods cause pain
|
|
|
Mumps (complications)
|
Meningoencephalitis, orchitis, epididymitis
|
|
|
Varicella (Incubation)
|
Herpes virus, 10-12 days, contagious 1-2 days before rash until all lesions have crusted over
|
|
|
Varicella (prodrome/rash)
|
Asymptomatic, fever, lethargy, back/ab pain, URI symptoms,
Rash: highly pruritic lesions that progress to teardrop vesicles and scab over, can have increased fever, HA, malaise |
|
|
Varicella (Tx)
|
Antihistamines, acetaminophen, antibiotic for secondary infections
|
|
|
Cat scratch disease (Etiology)
|
Bartonella henselae, gram (-) bacillus after cutaneous exposure to a cat—time between injury and lesion is 7-12 days, 5-50 days for lymph
|
|
|
Cat scratch disease (presentation & Tx)
|
Lesions (non-pruritic papules) then lymphadenopathy close to scratch site, fever, malaise, anorexia, fatigue, HA, usually resolves in 2-4 weeks,
Tx: anti-pyretics, moist wraps, azithromycin, clarithromycin, Bactrim, rifampin, cipro can be used if needed |
|
|
Meningococcal disease (Cause& S/S)
|
N. meningitides (gram (-), spread through respiratory secretions, incubation is 1-10 days, contagious until 24 hours on treatment
Bacteremia: fever, URI or GI symptoms, rash Meningococcemia: fever, chills, pharyngitis, conjunctivitis, myalgia, stiff neck, seizures, prostration, N/V, petechial rash leads to purpura & septic shock Complications: meningitis, peri/myocarditis, pneumonia, arthritis |
|
|
Meningococcal disease (Dx & Tx)
|
Dx: + culture Tx: Pen G, cefotaxime, chlor (if PCN allergic), rifampin for ppx, cipro for ppx, vaccinate
|
|
|
Lyme disease (Etiology)
|
Borrelia burgdorferi (spirochete), western deer tick is the carrier, risk is increased 36-48 hours after (NYMPHAL), 48-72 hours after (ADULT) bite, incubation from bite to rash is 1-55 days, late manifestations can occur up to one year
|
|
|
Lyme disease (Stage 1)
|
Localized disease: erythema migrans, fever, malaise, HA, arthralgia, stiff neck, rash remains for a few weeks, then fades, can be intermittent Erythema migrans: bulls eye rash (clear center)
|
|
|
Lyme disease (Stage 2)
|
Early disseminated: multiple skin lesions, smaller than 1st lesion, develop days to week after primary lesion, blood/lymph spread leads to disease in multiple organ systems(including 7 nerve palsy), can last for weeks to years without tx
|
|
|
Lyme disease (Stage 3)
|
Late disease—arthritis of the knees, can have late CNS sequelae, arthritis usually resolves but becomes recurrent and chronic
|
|
|
Lyme disease (Dx & Tx)
|
Dx: Culture from the edge of rash, 2 step testing (EIA, western blot)—if EIA is (-),
Doxy/tetracycline if PCN allergic |
|
|
Gonorrhea (STI, Etiology, S/S)
|
N gonorrhea gram (-) often asymptomatic
S/S: dysuria, discharge (thick/green/purulent), bleeding, dyspareunia, urethrtitis, cervicitis, gland abscess, exudative pharyngitis |
|
|
Gonorrhea (STI, Dx & Tx)
|
Dx: + culture Tx: Ceftriaxone 125 mg IM x1 dose Cefixime/cipro/levo use azithromycin/doxy if chlamydia also suspected
|
|
|
Botulism poisoning in an infant
|
Clostridium botulinum spores release toxins in GI tract, seen in infants <6 months, a/w honey intake (no honey under 12 months of age)
|
|
|
Botulism (S/S & Tx)
|
S/S: constipation, poor feeding, weakness, loss of head control, floppiness, decreased DTR, cranial nerve fxn decreased, decreased tone
Tx: hospitalize, stool softener |
|
|
Rocky mountain spotted fever
|
Caused by Rickettsia, transmitted via tick (incubation 1-14 days)
S/S: fever, myalgia, N/V, macular petechial rash starts on WRIST and ANKLES, spreads causing MULTIORGAN system disease (neuro deficits, murmur, crackles, decreased UO, jaundice) Tx: Doxycycline/tetracycline |
|
|
Pertussis (Etiology)
|
Spread by droplet, incubation is 6-21 days, contagious during catarrhal stage (adults transmit to infants)
|
|
|
Pertussis (Catarrhal stage)
|
1-2 weeks: cough, coryza, sneezing, fever
|
|
|
Pertussis (Paroxysmal)
|
2-4 weeks: staccato, paroxysmal cough with whoop, vomiting, cyanosis, exhaustion, In infants <6months: apnea, pneumonia, pulmonary HTN (no whoop)
|
|
|
Pertussis (Convalescent)
|
2-3 weeks: cough resolves
|
|
|
Pertussis (Dx & Tx)
|
Dx: + culture, leukocytosis can be seen
Tx: hospitalize infants, erythromycin, azithromycin as an alt |
|
|
Bacterial pharyngitis
|
Caused by GABHS, Neisseria gonorrhea, & diphtheria S/S: throat culture
Dx: throat cx Tx: PCN, amoxicillin |
|
|
Pharyngitis
|
Caused by adenovirus, coxsackie, echovirus, herpes, EBV, CMV
S/S: gradual onset, nasal symptoms, sore throat, cough, fever Tx: supportive care |
|
|
Myopia
|
“Nearsightedness” Visual image focused in front of the retina making it difficult to see things from far away
S/S: squinting, unable to read blackboard |
|
|
Hyperopia
|
“Far-sightedness” visual image focused behind the retina making it difficult to see things close up
S/S: HA, eye strain, may be asymptomatic (REFER) |
|
|
Epiglottitis (Etiology)
|
Severe inflammation of the supraglottic structures leading to life threatening airway obstruction, bacterial h. flu, staph, GABS, strep pneumo—most common 2-7 years
|
|
|
Epiglottitis (S/S)
|
High fever, severe sore throat, muffled voice, drooling, tripod position, irritable, toxic, cherry red epiglottis
|
|
|
Epiglottitis (Dx & Tx)
|
Dx: radiograph: THUMB SIGN
Tx: Emergency, keep child calm, antibiotics, maintain airway |
|
|
Peritonsillar abscess (Etiology)
|
Infection of tonsils and surrounding tissues, leads to abscess form
Caused by GABHS, staph, anaerobes, more common in adolescents |
|
|
Peritonsillar abscess (S/S)
|
fever, sore throat, toxic appearance, muffled voice, drooling, bad breath, unilateral tonsillar swelling, uvula displacement away from affected side
|
|
|
Peritonsillar abscess (Tx)
|
Refer—EMERGENCY, I&D, antibiotics
|
|
|
Retropharyngeal abscess (Etiology)
|
Posterior pharynx abscess with retropharyngeal nodes, caused by GABHS or staph aureus, most common in children <4 years
|
|
|
Retropharyngeal abscess (S/S & Tx)
|
S/S: high fever, severe sore throat, drooling, hyperextension of head, toxic appearing, stridor, prominent swelling of the post pharynx wall—diagnostic
Tx: Refer—EMERGENCY, I&D, antibiotics |
|
|
Cleft lip/palate
|
Failure of embryonic structures of the oral cavity to join palate, failure of palatal shelves to fuse
Tx: surgical repair, teach feeding technique |
|
|
Allergic rhinitis
|
IgE mediated response to allergens producing nasal mucosa inflammation
S/S: discharge, itching, tearing, snoring with sleep, allergic shiners/ salute, swollen boggy mucosa Tx: Nasal steroids, antihistamines, cromolyn, avoid allergens |
|
|
Epistaxis
|
Nose bleeds due to increased vascularity in Kiesselbach’s triangle, caused by trauma, dry nasal mucosa, infection, substance abuse, systemic disease
Tx: apply pressure to anterior nasal septum, tilt head forward, phenylephrine drops, packing, refer to ENT if repeat/severe |
|
|
Foreign body in the nose
|
S/S: unilateral, purulent discharge, sneezing, mild discomfort, rarely pain
Tx: remove object if possible, refer to ENT if unable to remove. |
|
|
Sensorineural loss
|
Damage to the COCHLEA/AUDITORY nerve, caused by noise,anomaly, meningitis, hyperbilirubinemia, kernicterus, gentamicin, LBW, measles, mumps, intracranial hemorrhage, HIGH FREQUENCY HEARING LOSS
|
|
|
Conductive Hearing loss
|
Blocked transmission of sound waves, can be congenital, OME, AOM, cerumen, FB, perforated TM, cholesteatoma, LOW FREQUENCY HEARING LOSS
|
|
|
Astigmatism
|
Refractive error due to irregular curvature of the cornea
S/S: eye pain, HA, fatigue, reading problems Tx: REFER, patching, corrective lens |
|
|
FB in the eye
|
S/S: PAIN, striation on the cornea, tearing, FB sensation, irregular pupil, perforated wound
Tx: DO NOT remove intraocular FB, irrigate to remove FB, topical antibiotic, patch eye |
|
|
Corneal abrasion
|
Caused by abrasions, trauma, FB, contact lens, UV light exposure
S/S: FB sensation, pain, photophobia, tearing, blepharospasm, decreased vision, + staining Tx: rest, topical antibiotic, oral analgesics, f/u in 24 hours, REFER |
|
|
Amblyopia
|
Decreased visual acuity caused by abnormal development, secondary to abnormal visual stimulation—result of strabismus, refractive error differences, sensory deprivation
S/S: wandering eye—red reflex, strabismus Tx: REFER, corrective lens, patching “good eye,” reassure, support |
|
|
Hyphema
|
Blunt trauma to the globe results in BLOOD IN THE ANTERIOR CHAMBER, can also be caused by bleeding disorders, leads to increased risk of glaucoma
S/S: drowsiness, pain, history of injury, light sensitivity, blood in anterior chamber, visual acuity changes Tx: REFER, decreased activity, rest in supine position with elevated head, patch eye, may need hospitalization |
|
|
Orbital cellulitis
|
Orbital: inflammation of the orbital contents, most common organisms staph, strep + H. flu, often associated with sinusitis/ethmoiditis Ophthalmoplegia, proptosis, decreased visual acuity, DECREASED OCULAR MOBILITY, lid edema, fever, headache
Tx: REFER, systemic antibiotic therapy |
|
|
Dacryostenosis
|
Nasolacrimal duct obstruction (blocked tear ducts) in an infant
S/S: continuous/intermittent tearing, discharge, blepharitis, nasal discharge Tx: massage, should disappear by 12 months—if not refer |
|
|
Chalazion
|
Chronic, inflammation/obstruction of the MEIBOMIAN gland in the POST MARGINS of the lids, nodular, NON-TENDER mass/cyst, red conjunctiva, if large can lead to astigmatism
Tx: warm soaks, erythromycin ointment or sulfacetamide drops, refer for I&D if does not resolve |
|
|
Hordeolum
|
Acute inflammation of the SEBACEOUS glands of the eyelids, usually caused by STAPH
S/S: sudden onset tenderness, redness, swelling with FB sensation, PAIN on palpation Tx: warm compresses, erythromycin/bacitracin ointment I&D (if severe) |
|
|
Blepharitis
|
Acute/chronic inflammation of the eyelash follicles and meibomian glands—can be seborrheic, ulcerated or bacterial (staph is the most common cause)
S/S: irritation/burning, FB sensation erythema, pruritus, loss of eyelashes, flaky/scaly debris or hard scales at base of eyelash (will bleed if removed) Tx: Moist compresses, wash with baby shampoo, topical antibiotic (erythromycin), selenium sulfide for seborrheic remove contact lens, throw away makeup |
|
|
Nystagmus
|
Involuntary horizontal/vertical/rotary/mixed movement of the eyes, can be familial also associated with albinism, refractive errors, CNS disease, ear disease, and retinal disease
Tx: refer to ophtho monitor, treat underlying cause |
|
|
Retinoblastoma
|
Intraocular tumor
S/S: squinting, eyes turn outward more than inward, may have a painful red eye, hyphema, pink mass, can be seen on fundoscopic, leukocoria, decreased visual acuity, photophobia |
|
|
Retinopathy of prematurity
|
Developmental vascular disorder that results in abnormal growth of retinal vessel and incomplete vascularization of the retina: EGA and LBW infants
S/S: leukocoria, optic nerve, pallor, glaucoma, cataracts, strabismus, detached retinas, retinal/iris changes, vitreous haziness/hemorrhage Tx: Monitor routinely, refer to vision services, yearly optho exam, cryosurgery |
|
|
Glaucoma
|
Increase in intraocular pressure due to a disturbance in the circulation of aqueous fluid, can be congenital or juvenile (trauma, disease, steroid use) Seen with Marfan, NF, Pierre Robins, congenital Rubella
|
|
|
Glaucoma (S/S)
|
Classic triad: tearing, photophobia, excessive blinking (blepharospasm)—hazy cornea, corneal edema or ocular enlargement
Secondary S/S: pain, vomiting, blurry vision, pupil dilation, erythema, asymmetry between eyes |
|
|
Glaucoma (Tx)
|
Surgery, topical beta blockers, topical carb anhydrase inhibitors—can result in blindness
|
|
|
Cataracts
|
Partial/complete opacity of the lens, can be congenital or acquired, unilateral/bilateral, can result in amblyopia
|
|
|
Cataracts (S/S)
|
Lens opacity, variable visual defects, hx of prenatal infection, drug exposure or hypocalcemia, black dots or white area in red reflex
|
|
|
Cataracts (tx)
|
Surgical removal of the lens with use of corrective lens, possible watch and wait, depending on severity
|
|
|
Normal visual development
|
20/40 by 3 years, 20/30 by 5 years, 20/20 by 6 years
Birth: sees and reponds to change, fixes on contrasts (B&W), + pupillary reflex, jerky movements 2-4 weeks: follows objects sporadically 3-4 months: recognizes parents smiles, focuses near and far, begin to develop depth perception, esotropia=normal 4 months: normal color vision 6-10 months: follows in all directions 12 months: close to fully developed |
|
|
Strabismus
|
TROPIA: constant deviation
PHORIA: intermittent deviation defect in ovular alignment, deviate outward (EXOTROPIA), deviate inward (ESOTROPIA), upward (HYPERTROPIA), downward (HYPOTROPIA) sclera between the cornea and inner canthus is obscured (PSEUDOSTRABISMUS) S/S: person squinting, head tilting, face turning, over pointing, decrease visual acuity, nystagmus |
|
|
Strabismus (diagnosis)
|
Corneal light reflex (Hirschberg test), cover/uncover, alternating cover
|
|
|
Strabismus (management)
|
Occlude/patch good eye, orthotic exercises, surgical alignment, corrective lenses
|
|
|
Conjunctivitis of childhood
|
Infection of palpebral lining of the conjunctiva, bacterial: S. aureus, HIB, strep pneumo, viral: adenovirus, HSV, varicella, allergic due to seasonal allergies
|
|
|
Conjunctivitis of childhood (S/S and Tx)
|
S/S: pruritus, FB sensation, tearing, HA, photosensitivity, watery, mucous, purulent mucous, erythema of the conjunctiva, chemosis, papillary hypertrophy
Tx: topical tobramycin, sulfacetamide, polymyxin, fluoro, refer if viral, allergic—treat underlying allergies |
|
|
Otitis externa
|
Acute infection/inflammation of external auditory canal, “swimmer’s ear”, also fungal, Caused pseudomonas and staph, more common in the summer due to water exposure
|
|
|
Otitis externa (S/S & tx)
|
S/S: itching, pain when moving the tragus, swollen EAC, pressure/fullness in the ear, black spots on TM (fungal)
Tx: analgesics, otic antibiotic drops (ciprofloxacin, polymyxin, Neosporin) mycotic drops (5% oric acid in ethanol), avoid water in ears, avoid cleaning the ears |
|
|
Acute otitis media
|
Acute infection of the middle ear—rapid onset of s/s of ME inflammation and effusion with MEE, Caused by S. pneumo, H. flu, M. catarrhalis
|
|
|
AOM (S/S)
|
Ear pain, irritability, fever, otorrhea, presence of MEE <bulging TM, erythematous TM, absent landmarks, possible fever
|
|
|
AOM Tx
|
Watchful waiting 48-72 hours if dx unclear, symptoms are not severe, child is over 6 months or over 2 years
1st line: Amoxil 80-90 mg/kg 2nd line: with fever, tx fail Augmentin 90 mg/kg PCN allergy: azithromycin, clarithromycin, ceftriaxone Tx all patients under 6 months, Treat all 6 mo-2years with definitive dx, Tx all patients over 2 yrs with severe illness, Treat pain with analgesics (acetaminophen/ibuprofen) |
|
|
Cholesteatoma
|
Epidermal cyst of the middle ear, can be congenital or acquired
S/S: vertigo, hearing loss, chronic OM with purulent discharge, pearly white lesion behind the TM Tx: Refer to ENT for surgical removal |
|
|
Sinusitis
|
Chronic >30 days, Acute >10 days infection and inflammation of paranasal sinus, caused by viral, bacterial (S. pneumo, H. flu, M. cat), or anaerobes
|
|
|
Sinusitis (S/S)
|
Major: facial congestions/fullness, fever (acute), purulent/discolored rhinorrhea, facial pain, nasal obstruction, hyposmia/anosmia
Minor: HA, halitosis, fatigue, dental pain, otalgia, cough |
|
|
Sinusitis (Tx)
|
Augmentin, Amoxil, PCN allergic: Azithromycin,
2nd line: cefuroxime/cefpodoxime/cefdinir |
|
|
Nasal polyp
|
Benign nasal tumor, think cystic fibrosis—refer for sweat test (also seen in allergic children), will look like a grape like mass between the turbinates
|
|
|
Retinal detachment
|
Caused by trauma (abuse), congenital abnormality (cataracts, Ehlers-Danlos, sicklers, Marfan) or retinal dz—Refer to ophtho
|
|
|
Retinal detachment (S/S)
|
Blurry vision, “flashing lights sensation,” darkening of retinal vessels
|
|
|
Burn to the eye
|
Can be thermal, chemical, or UV light
S/S: pale, necrotic appearance of surrounding skin, corneal opacity, decreased visual acuity, initial pain or delayed pain (UV burns), photophobia, tearing, swollen corneas, pinpoint fluorescein stain Tx: Topical anesthetic, immediate irrigation for chemical burns—REFER |
|
|
Charge syndrome (cardiac defect)
|
VSD,ASD
|
|
|
DiGeorge (cardiac defect)
|
Aortic arch anomalies, TOF
|
|
|
Downs (cardiac defect)
|
AV canal, AV septal defects, VSD
|
|
|
Marfan (cardiac defect)
|
Aortic root dissection, MVP
|
|
|
Noonan (cardiac defect)
|
PS, ASD
|
|
|
Turner (cardiac defect)
|
Co-arc
|
|
|
Williams (cardiac defect)
|
Supravalvular stenosis
|
|
|
S/S of congestive heart failure
|
Increased RR, poor feeding, reduced exercise tolerance, chronic cough, tachycardia, organomegaly, pallor, mottling, puffy eyelids, decreased pulses, wheezes, rales, poor weight gain, cyanosis
|
|
|
Major characteristics of TOF
|
4 defects: pulmonary stenosis, VSD, overriding aorta, RVH,
TET spells are often in the AM, acute increase in cyanosis with hypernea leads to limpness, LOC, rarely convulsions |
|
|
TOF (X-Ray)
|
Boot shaped heart
|
|
|
Transposition of the great vessels
|
Single S1, loud or slightly split S2,
Can have murmur from VSD or PS—when PDA closes=symptoms (ductal dependent) |
|
|
TGA (X-ray)
|
Egg on a string
|
|
|
Tricuspid atresia
|
Absent tricuspid valve and underdeveloped right ventricle, Single S1, ductal dependent
|
|
|
Pulmonary atresia
|
No pulmonary valve, under-developed right ventricle
|
|
|
Pathologic murmur
|
Murmur w/ a genetic syndrome, diastolic murmur, systolic murmur with a thrill or click, continuous murmurs that cannot be altered, fixed splitting of S2, loud S2 or S4, high grade, harsh in sound
|
|
|
Innocent murmur
|
Low grade and changes with positioning, will vary from visit to visit and with fever, anemia, excitement, musical or vibratory in sound, usually systolic, rarely radiation, Normal vs. EKG, health status
|
|
|
Venous hum
|
Continuous, SUPRACLAVICULAR, disappears when laying down or turning head, constant swishing sound, soft, no radiation
|
|
|
Supraclavicular bruit
|
Systolic, high pitched, harsh, heard in the SUPRACLAVICULAR FOSSA, minimal radiation, never heard below the clavicle, not affected by sitting/lying
|
|
|
Aortic stenosis
|
Thrill at RUSB, ejection CLICK, harsh systolic ejection murmur with radiation to the neck, a/w CHF & LVH
|
|
|
Pulmonic stenosis
|
Systolic murmur at the LUSB, with a CLICK (DECREASES with INSPIRATION, INCREASES with EXPIRATION) thrill at LUSB, radiates to back/sides, associated with other defects
|
|
|
Peripheral pulmonic stenosis
|
Systolic ejection, disappears by 6 months, lasts longer with Williams syndrome, congenital rubella, heard in the chest/axillae, loudest in the axillary, soft with middle/high pitch
|
|
|
Pulmonary flow murmur
|
Short, systolic ejection, louder with expiration, Upper LSB, RSB, transmits to the back, all ages, straight back, thin body, INCREASES WITH SUPINE POSITION, CARDIAC OUTPUT, FEVER, ANEMIA, soft blowing, no click or thrill
|
|
|
Still’s murmur
|
Short, systolic, musical, soft-blowing, vibrating, buzzing, “twangy string”, LLSB, LOUDER WHEN SUPINE, disappears with valsalva, common in 3-8 years
|
|
|
S/S of HTN
|
BP >95% x3, usually asymptomatic, headache, visual problems, dizziness, nosebleed
|
|
|
Primary HTN
|
No known cause, hereditary, stress, obesity
|
|
|
Secondary HTN
|
Co-arc, renal dysfunction, hyperaldoseteronism, plasma aldosterone, Cushing’s, pheochromocytoma, neural crest tumor
|
|
|
HTN Tx
|
Weight reduction, exercise, thiazide diuretics, beta blockers, ACE inhibitors, treat underlying disease
|
|
|
Kawasaki disease
|
Small vessel vasculitis, #1 cause of coronary artery disease, increased in males and Asians
|
|
|
Kawasaki disease presentation
|
Fever, warm swollen erythematous edematous hands and feet, polymorphous rash, cervical adenopathy, mucous membrane changes (strawberry tongue, red lips/gums)
|
|
|
Kawasaki disease criteria
|
Must have 5: arthritis, EKG changes, vomit/diarrhea, leukocytosis, thrombocytosis, increased ESR/CRP, conjunctival injection
|
|
|
Tx for Kawasaki disease
|
IV gammaglobulin (IVIG), Aspirin (to prevent clots)
|
|
|
Co-arctation of the aorta
|
Bruit at LUSB, 2-3/6 systolic ejection murmur with radiation of the left interscapular area, can have bicuspid aortic valve, DECREASE PULSE/BP IN LOWER EXTREMITIES
|
|
|
VSD
|
Most common CHD, 2-4/6 holosystolic murmur at LLSB, thrill if 4/6, LVH, LAH can occur, loudness of murmur does not indicate size of hol
|
|
|
ASD
|
Wide fixed split S2, 2-3/6 systolic ejection murmur, 2nd intercostal space, decreased hole (increased murmur), RVH, right axis deviation, cardiomegaly
|
|
|
PDA
|
Common in preterm infants, machinery like, diastolic/systolic murmur, can have hypertrophy
|
|
|
Jones Criteria (major)
|
Arthritis of the large joints, chorea, subcutaneous nodules, erythema marginatum, +/- emotional lability, carditis with valvular disease
|
|
|
Jones Criteria (minor)
|
Fever, arthralgia, increased ESR, CRP, prolonged PR interval, abdominal pain, malaise, epistaxis
|
|
|
Rheumatic fever (Dx & Tx)
|
Group A strep and 2 major OR major and 2 minor PCN, aspirin for arthritis, naproxen for inflammation
|
|
|
Hypertrophic cardiomyopathy
|
Can be dilated, have biventricular tract obstruction in infancy, murmur or be asymptomatic, MURMUR WILL INCREASE WHEN CHILD STANDS, a/w sudden cardiac death
|
|
|
Vesicle
|
Circumscribed elevated lesion <1cm with fluid
|
|
|
Pustule
|
Contains pus
|
|
|
Purpura
|
Non-blanching erythema due to blood in subcutaneous tissue
|
|
|
Lichenification
|
Thickened skin
|
|
|
Patch
|
macule >1cm
|
|
|
Bulla
|
Vesicle >1cm
|
|
|
Tumor
|
large nodule
|
|
|
Port wine stain
|
Purple/red macules that occur unilaterally and tend to be large on the face/occiput on neck, present at birth and persists through life with darkening/thickening, congenital malformations with dilated capillaries that will grow with the child
Tx: cosmetic, refer to derm Sturge Weber Syndrome |
|
|
Salmon Patch or Nevus flammeus
|
light pink macule most often found on the nape of the neck, eyelids or glabella, caused by a vascular malformation
Tx: will fade with time usually by 5-6 years |
|
|
Pityriasis rosea
|
benign self-limiting eruption in a Christmas tree pattern
|
|
|
Pityriasis rosea (S/S & Tx)
|
Highly pruritic, begins with herald patch that turns into maculopapular rash in 5-10 days, made worse by heat and bathing, can last 3-4 months
Tx: controlled sunlight |
|
|
Seborrhea dermatitis
|
Dermatitis secondary to overproduction of sebum Infants: erythematous, flaky, greasy, usually on the scalp, “cradle cap” Adolescent: mild flakes/scales on scalp/forehead/nasal bridge
Tx: oil to loosen flakes prior to washing, selenium sulfide, tar or salicylic acid shampoo, steroids may be needed if severe |
|
|
Tinea capitis
|
Dermatophyte (ringworm) infection of the hair/scalp, most common between 3-9 years/person to person transmission
|
|
|
Tinea capitis (S/S)
|
Red/skin colored scaly papules on the scalp, brittle hair, patchy alopecia, pruritus, can turn into a kerion (boggy inflammatory mass)
|
|
|
Tinea capitis (Dx)
|
Wood’s light=yellow/green , KOH exam
|
|
|
Tinea capitis (Tx)
|
Griseofulvin 15-20 mg/kg/day x 6-8 weeks, Lamisil 2-6 mg/kg/day x 2-4 weeks, selenium sulfide shampoo to prevent spread, must recheck, keep child out of school x 1 week
|
|
|
Atopic dermatitis
|
Most common dermatological disorder a/w asthma/allergies
|
|
|
Atopic dermatitis (S/S)
|
Papulosquamous red eruption with scales, papules, plaques, pruritic, dry
Infants: extensor surfaces, trunk, face, scalp Early to mid-childhood: flexural Late/middle childhood: skin creases, hand dermatitis, a/w secondary infections |
|
|
Acne
|
Abnormal keratination, increased sebum production, P. acnes, lysosomal enzymes lead to pustular lesions affects infants and adolescents
|
|
|
Mild acne Tx
|
Topical antibiotic (clindamycin/erythromycin), benzoyl peroxide, topical retinoids (Retin A, adapalene, tazavo)
|
|
|
Moderate acne Tx
|
Topical and oral antibiotics, contraceptives
|
|
|
Severe acne Tx
|
Retin A, Accutane
|
|
|
Pediculosis
|
Lice of the head (CAPITIS), body (CORPORIS), and genitals (PUBIC) transmitted from person to person through direct and indirect contact
|
|
|
Pediculosis (S/S)
|
Itch, “dandruff-like substance” in the hair, nits can be seen—head excoriated macules/papules can be present (body), bluish macules (pubis)
|
|
|
Pediculosis (Tx)
|
Pyrethrins/permethrin, Lindane as an alternative (can cause seizures), Ovide (malathion is flammable), home hygiene, eliminate lice
|
|
|
Scabies
|
Caused by sarcoptes scabiei, a mite that burrows into the skin, highly contagious, spread through contact/clothes/linen
|
|
|
Scabies (S/S)
|
Intense itching, linear S shaped burrows especially on finger webs and skin folds, can lead to encrusted papules
|
|
|
Scabies (Dx)
|
Microscopic exam of skin scraping
|
|
|
Scabies (Tx)
|
Permethrin cream (Elimite), repeat treatment in 1-2 weeks, antihistamines, treat family members, home hygiene
|
|
|
Impetigo
|
Superficial bacterial infection of the skin caused by staph or strep, often from trauma/insect bite
|
|
|
Nonbullous impetigo
|
Vesicles that rupture into moist/honey colored lesions
|
|
|
Bullous impetigo
|
Large, flaccid blisters that rupture leaving a coating/scale—can have fever, diarrhea
|
|
|
Impetigo (Tx)
|
Topical antibiotic (mupirocin, polymyxin B) if mild—oral antibiotic (cephalexin, dicloxacillin, erythromycin) can return within 24 hours once treatment is started
|
|
|
Staphylococcal scalded skin syndrome
|
Blistering skin disease from epidermolytic toxin producing staph
S/S: abrupt onset fever, malaise, tender erythematous skin, + Nikolsky sign (peeling of skin with light rubbing), crusty sign/skin around mouth/nose Tx: admitted for IV, avoid steroids, minimal handling |
|
|
Molluscum contagiosum
|
Pox virus spread through contact and autoinoculation
S/S: multiple flesh toned/pink, umbilicated papules on the face/trunk/extremities Tx: watchful waiting, tretinoin/differin or cryotherapy |
|
|
Allergic contact dermatitis
|
Type 4 (T-cell mediated) reaction, lesions develop 48-72 hrs post exposure, common allergens include nickel/neomycin/poison ivy or sumac
S/S: vesicular/eczematous eruption with linear papules (Koebner phenomenon) Tx: avoid allergens, systemic steroids, topical steroids |
|
|
Diaper dermatitis
|
Caused by friction/irritation due to urinary wetness
S/S: only in diaper area, erythematous, eroded or ulcerated in severe cases Tx: keep area clean/dry, limit diaper use, treat associated candidiasis with nystatin/lotrimin |
|
|
Warts
|
Viral infection with HPV, transmitted by direct/indirect contact
|
|
|
Verruca vulgaris
|
Common wart, affects digits and periungual region
|
|
|
Verruca plantaris
|
Plantar wart, self limited
|
|
|
Verruca plana
|
Flat wart
|
|
|
Wart Tx
|
Cantharidin, salicylic acid, cryotherapy, surgical laser ablation, duct tape
|
|
|
Giardia lambblia (S/S)
|
Abdominal cramps, flatulence, bloating, anorexia, weight loss, FTT, may be intermittent, protracted, or debilitating disease, asymptomatic infection is common, diarrhea: rarely bloody, watery, greasy, foul smelling
|
|
|
Giardia lamblia (Tx)
|
Metronidazole 15 mg/kg per day in 3 divided doses for 5 days, Nitazoxanide (Alinia) Children 1-4 years old 100 mg twice a day for 3 days; children 5-11 years 200 mg twice a day for 3 days, Tinidazole 50 mg/kg/dose (max single dose 2 grams)
|
|
|
Enterobius vermicularis (pinworms) (Tx)
|
Mebendazole, 100 mg table for 1 dose, then repeat in 2 weeks OR Pyrantel pamoate 11 mg/kg (max 1 g) for 1 dose then repeat in 2 weeks, Albendazole Vaginitis is self limiting, simultaneously treat family members, reinfection is common
|
|
|
Ascaris lumbricoides (round worms)
|
Worms in stool or vomit, bowel or biliary obstruction, peritonitis, common bile duct obstruction, biliary colic, cholangitis or pancreatitis—most infections are asymptomatic
Tx: Albendazole 400 mg single dose; mebendazole, 100 mg tablet twice a day for 3 days or 500 mg one Ivermectin 150-200 mcg/kg as a single dose; surgical intervention may be necessary |
|
|
Taenia (tapeworm)
|
Worms in stool, abdominal pain, nausea, diarrhea, excessive appetite—infection often asymptomatic
Tx: Praziquantel 5-10 mg/kg once, Niclosamide 50 mg/kg once, Nitazoxanide children 1-3 yrs 100 mg twice a day for 3 days; children 4-11 years old; 200 mg twice a day for 3 days |
