Shared Flashcard Set

Details

Clin Med III Pediatrics
Pediatrics
214
Medical
Graduate
08/10/2010

Additional Medical Flashcards

 


 

Cards

Term
birth wt is tripled
Definition
in the 1st year
Term
average wts at 1,5,10yrs
Definition

1yr - 10kg

5yr - 20 kg

10yr - 30 kg

Term
ht averages at birth, 1yr, 3 yr
Definition

birth - 20inch

1yr - 30 inch

3 yr - 3ft

Term
Head circumference (HC)
Definition

Birth average -  35 cm

0 to 2yrs - increase 1cm/mo

2+ yrs - 10 cm growth for the rest of life

Term
normal gestational term
Definition
37 to 42 weeks.
Term
gestational age assessment tool that tests neuromuscular and physical maturity
Definition

Ballard Scale

FYI, not on exam...

The Physical criteria

1. Skin

2. Ear/Eye

3. Lanugo Hair

4. Plantar Surface

5. Breast bud

6. Genitals

 

The Neurological criteria

1. Posture

2. Square Window

3. Arm Recoil

4. Popliteal Angle

5. Scarf sign

6. Heel to Ear

Term
AGA wt (appropriate for gestational age)
Definition
2500 g (5.5lbs)
Term
Apgar score
Definition

to determine quickly whether a newborn needs immediate medical care - at 1 and 5 minutes.

 

Rate the following from 0 (poor) to 2 (perfect): 

Appearance (color)

Pulse (should be greater than 100)

Grimace (relflex irritability)

Activity (muscle tone, resisting extn)

Respiratory (breathing, strong cry)


total perfect score-10

Term
most common congenital newborn infections
Definition

TORCHeS

T: toxoplasmosis

O: other (HIV, parvovirus B19)

R: rubella

C: cytomegalovirus (most common)

He: herpes simplex virus

S: syphilis

Term
the most common congenital newborn infection
Definition
CMV
Term
AVPU scale
Definition

A Shortened glascow coma scale.


A - Alert

V - response to voice

P - response to pain

U - unresponsive.

 

Anything less than A needs immediate medical attn.

Term
if newborn cyanosis extends to ___________, look for possible causes.
Definition
if newborn cyanosis extends to mucous membranes, look for possible causes.
Term
nl newborn vital
Definition

HR 120-160

RR 30-60

take temp rectally

Term
Acrocyanosis
Definition
persistent blue or cyanotic discoloration of the digits, most commonly occurring in the hands although also occurring in the face and feet as well.
Term
Lanugo
Definition
Lanugo grows on fetuses as a normal part of gestation, but is usually shed and replaced by vellus hair at about 33 to 36 weeks of gestational age.
Term
physiologic jaundice
Definition
intrauterine phase, babies have hypoxia (incr RBC to compensate). After birth, excessive RBCs lysed = physiologic jaundice at 3 days to 1 wk after birth.
Term
breastfeeding jaundice
Definition
during 1st wk, caused by poor calorie intake/dehydration. Tx: more frequent breastfeeds.
Term
keritin filled cysts in newborns around eyes and mouth
Definition

milia

[image]

Term
sweat gland ducts get plugged due to dead skin cells or bacteria around ears and neck - usually in hot/humid environments
Definition
miliaria[image]
Term
blotchy red spots on the skin with overlying white or yellow papules or pustules, benign, self-limiting.50% of fullterm newborns, occuring 2-5d after birth. etiology unknown.
Definition
erythema toxicum neonatorum[image]
Term
6+ more café au lait >5 mm in diameter before puberty, or >15 mm in diameter after puberty, is pathopneumonic for....
Definition
neurofibromatosis type I
Term
Appears during the first weeks of life and resolves by age 10. In infancy, it is the most common tumor
Definition
hemangioma (stork bite)
Term
closure of fontanelles
Definition

posterior closes at 2 months

anterior closes 7-18 months (ave 2 yrs)

 

sunken= dehydration

bulging = increased intracranial pressure

[image]

Term
Molding (mis-shapen heads of newborns) could be caused by what 2 things?
Definition

caput succedaneum - caused by vaccum extraction during delivery, babies look like cone heads

[image]

cephalohematoma - hemorrhage of blood between the skull and the periosteum

[image]

Term
softening of the skull bones, especially along suture lines - abnormal
Definition
craniotabes
Term
TM appearance up to 1 month
Definition
gray, dull, immobile  - this is normal
Term
whitish-yellow cysts that form on the gums and roof of the mouth of newborn baby.
Definition
Epstein pearls
Term
abnormally increased distance between two organs or bodily parts, usually referring to an increased distance between the eyes
Definition
Hypertelorism (orbital hypertelorism)
Term
skin fold of upper eyelid covering inner corner of eye[image]
Definition
epicanthal folds - seen in down syndrome
Term
  • A smooth philtrum — The divot or groove between the nose and upper lip flattens
  • Thin vermilion — The upper lip thins
  • Small palpebral fissures — Eye width decreases
Definition
fetal alcohol syndrome[image][image]
Term
no red reflex could signify (2)...
Definition
congenital cataract, or retinoblastoma
Term
webbing of the neck
Definition

turner's syndrome - 1:2500 girls, 1 X chromosome is missing or abnormal.

[image]

Term
gradient more than 10mmHg between upper and lower extremities
Definition
coarctation of the aorta
Term
heart sounds on newborn
Definition
more midline, murmurs are normal and transient
Term
atrial septal defect results from...
Definition
non-closure of foramen ovale which usually close with pressure changes.
Term
heart sounds - normal and pathologic
Definition

normal - s1, s2 splitting (s2 with inhale); s3

 

pathological ALWAYS - S4

Term
murmurs - physiologic and pathologic
Definition

physiologic - asx, SYSTOLIC, <3/6

 

pathologic - systolic >3/6 and DIASTOLIC

Term
on auscultation of newborn, you hear widely fixed split S2
Definition

ASD - foramen ovale did not close

spontaneous closure in 90% (<3mm), surgery for larger defects

Term
HEART SOUNDS & MURMURS - REVIEW
Definition

S1 - systole, closure of mitral valve (and tricuspid)

 

S2 - diastole, closure of aortic valve (and pulmonary valve

 

S3 - ventricular gallop.  ¨ken-tuc-ky¨ middle of diastole, oscillation of blood between walls of ventricles indicating increased blood volume in ventricles.  Listen w/ bell.  Later in life, could mean dilated CHF.

 

S4 - atrial gallop. ¨Ten-nes-see¨ just befort S1 at apex in LLD position holding breath.  Blood being forced into stiff/hypertrophic ventricle.

[image]

GRADES 1-6.  3/6 is loud.  4/6 has palpable thrill. 6/6 heard without stethoscope.

 

Term
10% of congenital heart disease.  2:1 females
Definition
ASD
Term

auscultation of newborn reveals holosystolic murmur.

complications?

Definition

Ventral Septal Defect-->can lead to pulm HTN and CHF (leading to failure to thrive aka FTT).

 

Spontaneous closure up to 50%.  Surgical repair for FTT and HF.

Term
20-60% of congenital heart disease, more males.
Definition
VSD
Term

Machinery-like murmur in 2nd intercostal space, bounding peripheral pulses, and wide pulse pressure on newborn

 

Definition

Patent Ductus Arteriosus

L to R shunt between aorta and pulm artery.

Larger defect could cause left heart failure.

 

[image]

 

Term

Patent Ductus Arteriosus

1) possible cause

2) is it normal?

3) tx

Definition

Patent Ductus Arteriosus

1) possible cause - maternal rubella

2) is it normal? yes, in full term newborns, dissapears in 12-24 hrs

3) tx - indomethacin for closure or surgery

Term

a type of abdominal wall defect in which the intestines, liver, and occasionally other organs remain outside of the abdomen in a sac because of a defect in the development of the muscles of the abdominal wall.

The sac, which is formed from an outpouching of peritoneum, protrudes in the midline, through the umbilicus (navel).

Definition

omphalocele

[image]

Term
inability to retract the distal foreskin over the glans penis.
Definition
phimosis
Term
female genitalia exam on newborn
Definition

normal mucoid discharge (even bloody); identify urethral and vaginal openings; clitoris size to exclude ambiguous genitalia

Term
newborn - 1 arm is immobile
Definition
clavical fracture
Term
girls, breech deliveries, asymmetric legs, gluteal folds
Definition

t/c hip dysplasia

 

Barlow Test is for diagnosis: push the ball of the hip rearward out of the socket.

 

Ortolani test is a maneuver to reduce a recently dislocated hip.

Term
most common congenital disorder of the lower extremity
Definition
clubfoot (talipes equinovarus)[image]
Term
sole of foot bones bend toward midline of the body
Definition
metatarsus varus (adductus)[image]
Term

Primitive Reflexes

1) Moro

2) Rooting

3) Palmar

4) plantar/babinski

5) Tonic neck/fencer's position

Definition

1) Moro reflex - startle response.  Legs and head extend, arms jerk up w/ palms up and thumbs flexed.  Then, arms brought together and clenched into fists.  Gone by 2 months.

 

2) Rooting reflex - assists breastfeeding.  Head turns to anything that strokes cheek/mouth and then searched for object by moving head in decreasing arcs.  Gone by 4 months.

 

3) Palmar grasp - gone by 6 months.  Palm is stroked, fingers close.

 

4) plantar reflex (BABINSKI) - dorsiflexion of toes when foot stroked, normal response, should be gone by 2 yrs.  Sign of UMN lesion in adults.

 

5) Tonic neck reflex (FENCER'S POSITION) - head rotated to one arm and arm extends, while other arm flexes and fist clenched.  REverse happens when head is turned.

Term
babinski reflex should dissapear by age...
Definition
2 years
Term
Delay in language acquisition should prompt...
Definition
hearing evaluation (sensory, conductive) for hearing loss
Term
how many primary teeth?
Definition
20
Term
% of kids with innocent murmurs (systolic, <3/6)
Definition
50%
Term

non cyanotic congenital heart defects:

 

1) systolic murmur in pulmonic area with wide split of S2

2) pansystolic murmur on LSB with thrill

3) continous diastolic + systolic murmur

Definition

non cyanotic congenital heart defects:

 

1)ASD: systolic murmur in pulmonic area with wide split of S2

 

2)VSD: pansystolic murmur on LSB with thrill

 

3)PDA: continous diastolic + systolic murmur

Term
Causes of precocious puberty
Definition

CNS tumor

gonadal tumor

congenital adrenal hyperplasia

Term
causes of delayed puberty
Definition

constitutional (FHx of delayed puberty & short stature)

malnutrition

chronic disease

chromosomal

Term
2 y/o is seizing - what to do
Definition

1) ABCs

 

2) Hx - choking, aspiration, apnea, poor ventilation, arrythmias

 

3) Labs - Na, BG, Mg, Ca

 

4) Give Meds: diazepam, lorazepam, fosphenytoin, coma induction

 

5) reassess vitals, mental status, irritability, PE

Term
Differential  dx for Seizing kid with abnormal neuro exam
Definition

Lytes/glucose

CNS mass/bleed/abcess/trauma

bacterial/viral meningitis

encephalitis

shigella

todd's paralysis

ingestion

Term
differential for seizuring kid with normal neuro and physical exams
Definition

epilepsy

febrile seizure

Term
Hx of progressively worsening vomiting, H/A, fever, irritability, photophobia.
Definition

BACTERIAL MENINGITIS

 

dx:

kernig's, brudzinski (NOT ACCURATE FOR KIDS < 1 YR!) paradoxical consolability - don´t want to be touched stiff neck

DO lumbar puncture (but not w/ incr ICP)

Term
most common etiology of bacterial meningitis
Definition
Lyme - easy to treat and good prognosis
Term
etiologies of neonate bacterial meningitis
Definition
E Coli, Listeria, Group B strep
Term
etiology of bacterial meningitis in older children
Definition

Neisseria meningitidis (meningococcus)

Streptococcus pneumoniae (pneumococcus)

<5y/o= H. influenzae type B (in non immunized).

Term

tx and mortality for bacterial meningitis in neonates and older kids

 

supportive therapy

 

% with neuro damage complications

Definition

Neonates - cefotaxime, ampicillin covers listeria, 5-10% death.

 

Older kids - cefotaxime, vancomycin, 15-20% death.

 

Supportive therapies - BP, ICP, anti-epileptic meds

 

Neuro damage in 30% = delay and impaired hearing.

Term

epidemiology of febrile seizures

1) % of kids

2) age range

3) duration of seizure

Definition

2-4% of kids

6 mos to 6 years

less than 15 minutes (ave less than 5 min)

Term
2 common causes of child fevers which can cause febrile seizures
Definition

roseola (HHV6) and AOM

 

**Note, often FHx of febrile seizures, no increased risk for epilepsy**

Term
atypical febrile seizures - f/u
Definition
EEG, MRI
Term
most common bacterial infection in peds
Definition
AOM: S. pneumoniae (pneumococcus), H. influenza, M. catarhallis
Term
viral etiologies of AOM
Definition
rotavirus, adenovirus, RSV, influenza, parainfluenza
Term

Not sleeping well, Hx of URI symptoms, not drinking well, not wanting to lie down, new fever, tugging at ear

 

dx, tx, complications

Definition

Dx - AOM

Tx - can wait 48 hours. amox, augmentin, 3rd generation cephalo for pseudomonas coverage.

 

other tx - Bilat myringotomy (tubes)

 

Complications: perf (self resolving), mastoiditis, meningitis, hearing impariment.

Term
persistant OM +/- effusion, consider what bacterial agent
Definition
pseudomonas - treat with 3rd generation cephalo like Fortaz (Ceftazidime)
Term
a sore throat lasting 5-7 days, r/o...
Definition

strep.

 

because....strep gets better in 3 days even w/o treatment and is accompanied by h/a, fever, abdominal pain.

Term
3-4 wks of fever with sore throat + lymphadenopathy
Definition
cat scratch dz (bacteria bartonella)
Term
10-14 d ugly exudative sore throat
Definition

EBV (infectious mononucleosis)

fever, sore throat, and posterior cervicle lymphadenopathy. Sometimes, a swollen spleen or liver involvement may develop

Term

fever, abd pain, h/a, rash, palatal petechiae +/- URI sx and AOM

 

dx, testing, tx, complications

[image]

Definition

Strep Throat - GABHS.

 

dx - Rapid strep 95% effective.

Tx if high clinical suspician but tests negative.

 

tx- PCN, amox suspension for taste, clindamycin for reccurent strep

 

complication -  retro/parapharyngeal abcess, AGN, rheumatic fever.

Term
peritonsillar abcess - tx
Definition
complication of strep throat. tx with I&D with local lidocaine at bedside.
Term
retropHARYNgeal abcess - best method to diagnose
Definition
Radiograph. tx is I&D asap.
Term
one of most common reasons for pediatric admission
Definition
dehydration. (70% water, greater insensible losses, less ICF than adults)
Term

sunken fontanelles and eyes, clammy skin, cap refill >3sec, impalpable pulse, parched mucosa.

 

these sx represent % of water loss in infant and child?

Definition

infant - 15%

child - 9%

Term
3-5% fluid loss, how do you rehydrate
Definition
oral rehydration (not recommended: apple juice, coke, gatorade, ginger ale, milk, orange juice)
Term
calculate deficit for IV hydration to be given over 24 hrs
Definition

(%hydrated/100) = (current wt/well weight)

 

eg: 10% dehydrated 11kg child

 

90/100=11/x

x=12.2

so...give 1.2 liters of IV fluid over 24 hrs

Term
initial rehydration, bolus dose then maintenance dose
Definition

bolus 20ml/kg

 

Maintenance (ml/hr) =

4ml x 1st 10kilos

2ml x 2nd 10kilos

1ml x rest of kilos

 

IN ADDITION, give deficit over 24 hrs=

50% over 1st 8 hrs

50% over 2nd 16 hrs

Term
Predominantly neurologic symptoms: Lethargy, weakness, altered mental status, irritability, seizures, also muscle cramps, depressed deep tendon reflexes, and respiratory failure can be due to...
Definition
hypernatremic dehydration from GI and skin losses. Replace free water loss over 48 hrs
Term
GI losses, CF, skin losses, 3rd spacing... cause what type of dehydration
Definition
hyponatremic dehydration. replace fluids over 24 hrs
Term

characterized by some combination of apnea, color change, change in muscle tone, choking, or gagging.

 

whats your work up for this kid?

Definition

apparent life threatening event

 

Neuro - CT scan, EEG, pneumogram

Pulmonary - CXR, pulse ox, influenza

Cardiac - ECG, echo

GI - upper GI, pH probe

Term
risks for SIDS (on the rise in the last 3 years)
Definition
Male Gender, African-American, Low BW, Prematurity, Maternal Smoking, Winter Season, Young Maternal Age, Single parenthood, multiple gestations, Higher Parity
Term
child abuse - % diagnosed in ER, % physical, sexual, neglect
Definition

2.5% diagnosed in ER

 

50% neglect, 30% physical, 20% sexual

Term
fractures that suggest abuse
Definition
metaphyseal bucket handle, corner fx, multiple fx, posterior rib, scapulae, skull fractures that are multiple/complex/occipital/posterior parietal, spinous process fx, spiral fx in non ambulatory infant
Term
what is diagnostic of skull fractures (should be done if abnl cranial or neuro exam)
Definition
CT
Term
most common victims of sexual abuse
Definition

girls 8-12 yrs

 

RISKS: poor child-parent or parent-parent relationships, and a nonbiologically related male in house increase risk.

Term
when is rape kit done
Definition
over 12 yrs or penetration
Term
adolescent age
Definition
11/12 to 18/21 years
Term
when does puberty end
Definition
16-18
Term
highest cause of adolescent death ages 15-19
Definition

unintentional injury 50%

 

homicide 14%

suicide 12%

 

 

Term
where are prominent developementa transformations in adolsecents brain's seen
Definition
prefrontal cortex and limbic brain
Term
what happens to testosterone levels during puberty
Definition
testosterone increases 20x
Term
hormonal changes during puberty
Definition

gonadotropin releasing hormone GnRH released from hypothalamus

 

stimulates release of FSH, LH from ant pituitary

 

stimulates gonads to produce estrogen/testosterone

Term

Max growth for girls and boys

 

% of ht achieved during this time

Definition

girls 11.5-12: fat location changes

SMR3-4 breast development

SMR3 pubic hair development

 

boys 13-14 (longer): fat quantitiy increases, muscle mass doubles between 10-17.

 

 

80-90% ht achieved

Term
Sexual Maturation Ratng (TANNER)
Definition

 

SMR 1 = prepuberty (9 and younger)
SMR 2= pubic hair is sparse, fine, non-pigmented. (10-11)
¡Male: genital development occurs in SMR 2.  testes become larger and scrotal skin reddens and coarsens. 
¡Female: breast buds develop
SMR 3= pubic hair increases, becomes curly and more pigmented (12-13)
¡Male: Penis lengthens
¡Female: breast and areolar tissue enlarge and elevate.
SMR 4= pubic hair adult in texture, but limited in area (13-14)
¡Male: Penis enlarges and scrotal skin becomes pigmented. 
¡Female: areola and nipple form a separate mound
¡
SMR 5 = adult maturity. (14+)
¡Female: areola assumes same contour as rest of breast
¡
Pubic hair development precedes axillary by more than a year. 
Term
ave age of menarche
Definition
12 (10-16 average)
Term
breast buds at what age
Definition
8-11 - growth may be asymmetric
Term
every adolescent visit, do vitals, which include
Definition
ht, wt, BMI and compare to last visit
Term
gynecomastia: what % of boys have transient subareola breast tissue in what SMR/tanner stage?
Definition
60-70% in SMR 2-3 (resolution can take up to 2 yrs)
Term
indications for 1st pap smear
Definition

at age 21 or within 3 yrs of sex (no longer current guidelines)

 

OR if presenting with abd pain, STIs, menstrual irregularities, before starting OCP

Term
is the rhythm method effective in adolescents
Definition
no, because of irregularities in mentrual cycles
Term

Early, middle, late adolescence - ages and social characteristics

 

Definition

Early 10-13: concrete thoughts, unrealistic goals, more comfortable with same sex

 

Middle 14-16: emotions, mood swings, abstract thinking, self-centered, autonomy from parents

 

Late 17+: idealism (concrete concepts of right and wrong), less self-centered, realistic goals for future

Term

age at

 

1) gender identity

2) sense of masculine/feminine

 

Definition

age at

 

1) gender identity at age 2

2) sense of masculine/feminine at age 5-6

Term
antidepressants in adolescents
Definition
black box warning of suicide in children/adolescents
Term
3rd most common chronic illness of american teen girls
Definition
anorexia
Term
% of eating disorders comprised of men
Definition
10%
Term

criteria for anorexia inpatient tx - when to admit

1) body wt

2) HR

3) two clinical presentations

4) K+ level

5) wt loss

6) previous experience

7) current

Definition

oBody weight < 75% of ideal body weight
—Supine heart rate < 45/min
—Symptomatic hypotension or syncope
—Hypokalemia: K+ < 2.5 mEq/L
—Rapid weight loss that cannot be interrupted as outpatient
—Failure of outpatient management
—Acute food refusal

Term

adolescent suicide

 

1) highest rate

3) highest rate of unsuccessful suicides

Definition

adolescent suicide

 

1) highest rate - white males

3) highest rate of unsuccessful suicides - 3x higher in females

Term
specific lab for obese teens
Definition
cholesterol levels
Term

occurs between 2-4 wks after birth in 20% of newborns.  inflammatory papules/pustules on face.

 

dx

resolved when?

cause?

Definition

acne neonatorum

resolves by 6-12 months

Presumed to be due to hormonal withdrawal

Term

1-2 mm white papules on face.  Epidermal cysts filled with keratin.  40% of newborns.  rupture spontaneously.

 

dx

if present in mouth, called what?

Definition

Milia

 

In mouth - Epstein Pearl (85% of newborns)

Term

blue black macule over lumbosacral area.  Also on shoulders, back, butt.

[image]

dx

prevalence?

tx

Definition

Mongolian spots (can be mistaken for child abuse)

90% of native am, afr am, asain newborns

fades as child ages

 

Term

red, rubbery nodules.  benign tumors of capillary endothelial cells, present by 2-4wks after birth.

 

dx

when does it go away

when is immediate tx needed, how to tx?

Definition

Hemangioma

90% gone by age 9

tx if obstruct vision, airway, cardiac decompensation

tx w/ prednisone 2-3mg/kg x 6-12 wks

2nd line: interferon if not responding.

[image]

Term

50% of newborns get this within 1-2 days after birth. Splotchy, erythematous macules on trunk, face, extremities.

 

dx

may be associated with what?

when does it go away?

Definition

erythema toxicum

 

may be assoc w eosinophilia in blood

gone by day 7[image]

Term

greasy yellow scale that affects primarly the scalp in infants (cradle cap)

 

dx

tx

Definition

seborrhea

 

tx: spontaneously resolve at 8-12months, DON'T USE keratolytic shampoos like nizorel.

 

USE low potency steroids.[image]

Term

whitish plaques on erythematous base on buccal mucosa

 

dx, tx

Definition

Thrush - candida albicans

 

tx: nystatin susp QID

fluconazole PO

breastfeeders - treat mother's nipples topically

Term

occlusion of the sebaceous follicle opening produces clinical lesions on face, upper chest, back.

 

neonatal and adolescent

complications

types of clinical manifestations

tx

Definition

acne vulgaris

 

neonatal - appears 2-4 wks, gone by 6 months

adoescent - appears 8-10 years

 

complication: cystic acne requires attn ASAP b/c of scarring.  can form sinus tracts

 

manifestations:

open comedone/black head - predominant lesion in early adolescent acne.  obstruction at follicular mouth

closed comedone/white head - obstruction beneath follicular opening.  precursors of inflammatory acne lesions

 

tx: benzoyl peroxide

PO/topical ABX

topical retin A

OCP

Accutane as last resort

 

 

Term

exposed areas (face and extremities) or diaper area of infants.  begins as smal vesicles easily ruptures...erosions by covered by moist, honey-color crusts. occurs in warm climate months.  enhanced spread by crowding.

 

dx, etiology

tx

Definition

Impetigo - staph aureus or GABHS.  VERY CONTAGIOUS.

 

tx: PO ABX - cephalexin (KEFLEX) and cefaroxil (DURICEF)

topical BACTROBAN TID

HAND WASHING - stress this![image]

Term

grouped vesicles on erythematous base on lips, cheeks, chin, or eyes. preceded by tingling sensation 85% of time in recurrent cases.

 

dx

1) types

2) incubation pd

Definition

herpes simplex virus I -

 

dx by Tzank smear (scrape with #15 blade, smear of glass slide, stain with Wright stain.  Positive if multinucleated giant cells indicates HSV or VZV.

 

1) types - primary, reccurrrent

2)  incubation pd - 2 to 12 days

Term
swollen, painful, erythematous lesions with deep rooted vesivles of distal phalanx.[image]
Definition

herpetic whitlow

 

*seen in thumb suckers often* results from innoculation of HSV through cutaneous break.

Term
treatment for herpes simplex/whitlow
Definition

acyclovir PO QID or topical

penciclovir q 2 hrs x 4 days

avoid precipitating factors

Term

flesh, white, or yellow colored papules with central umbilication/indentation, diameter 1-15 mm on extremities, head, neck (type I) OR on genitals (type II)

 

dx and etiology

incubation

contagious?

tx

Definition

dx: molluscum contagiousum

(pox-virus induces benign epidermal cell proliferation)

 

incubation 2-7wks

contagious as long as active lesions present

 

tx: cantharidin or trichloroacetic acid 25% applied with wooden toothpick to central umbilication and then neutralize with alchohol.

OR cryotherpy is best.

 

[image]

Term
benign viral HPV tumor causing epidermal cell proliferation
Definition

verrucae

 

common - verruca vulgaris - papule with irreg, scaly border.

 

flat - verruca plana - multiple, flat-topped, broad, skin colored papules, affinity to face and extremities

 

plantar - verruca plantaris - papule is pushed into the skin

 

venereal - condyloma acuminata - multiple confluent papules w/ irregular surface on genital mucosa or adjacent skin

Term
verrucae tx
Definition

cryotherapy, salicyclic acid, retin A cream, podophyllum, surgery

 

80% recurrence

Term

well demarcated lesion with central clearing, scaling, +/- erythema, alopecia, broken hairs

 

dx

tx

complication

Definition

tinea capitis

 

tx: griseofulvin PO up to 6months with fatty foods

topical nizoral, selsun blue as adjunct

 

complication: kerion, a boggy nodule with pustules

Term

well demarcated lesion with papular boder and central clearing, scaling, erythema, contagious, self contamination.

 

also called ringworm

Definition
tinea corporis
Term
well defined bordered plaques in groin with widespread erythema.  very pruritic.  also called jock itch
Definition
tinea cruris
Term
tinea cruris, tinea corporis - tx
Definition

topical antifungals 90% effective - lotrimin, nizoral (ketoconazole) x 4 wks

 

other: cotton, airing, no underwear during sleep

Term

thick, s/f, exaggerated, scaling, cracked erythematous skin w/ macerated moist pruritic skin btwn toes

 

athletes foot

 

dx

tx

Definition

tinea pedis

tx: topical antifungal or antifungal/steroid combos

betamethasone .05%, clotrimazole 1% BID x 12 wks

Term

multiple oval macules (hypo/hyperpigmented) with fine scales on neck, chest, upper back, shoulders, non-contagious yeast found on all humans

 

dx

tx

Definition

tinea versicolor - pityrosporum ovale

 

tx: topical azoles or selenium sulfide BID x 4 wks

 

Term

diaper rash - beefy red papules or plaques on skin in the folds of infants with satellite lesions

 

1) dx

2) often follows what?

3) labs

4) tx

Definition

1) candida albican

2) ABX use

3) KOH prep = budding yeast hyphae

4) tx: topical antifungals QID x 5 days, educate about hygeine, air out

Term

GABHS mediated rash - fine macules and papules on neck and spreading down to trunk and extremities, NO PALMS AND SOLES. 1-2mm papular elevations giving sandpaper quality

 

1) dx

2) ages

3) appears how long after infection

4) associated s/s

5) labs

6) tx

Definition

1) dx: scarlatina, scarlet fever.

2) ages - 2 to 10 years

3) appears how long after infection: 1-2 days

4) strawberry tongue, generalized lymphadenopathy, desquamation

5) labs: throat culture positive

6) PCN, ampicillin, amox

PCN allergy= use erythromycin

Term

prodromal s/s followed by maculopapular erythematous rash on forehead and face, spreading down to neck, body, extremities, KOPLIK'S SPOTS( small red lesions with blue-white centers on oral mucosa and conjuctiva)

 

1) dx

2) type of virus

3) transmission

4) contagiousness

5) tx

Definition

1) dx: measles (rubeola)

2) type of virus: RNA

3) transmission: transfer of nasopharyngeal secretions

4) contagiousness: 5 days after exposure to 4-5 days after rash gone

5) tx: supportive, monitor for 2º infections, encourage vaccination (NO RELATION BTWN AUTISM AND VACCINE)

Term

Prodromal s/s plus anorexia, paiinful enlargement of salivary glands under ears/jaw on one or both sides of face (parotitis)

 

1) causative agent

2) time of year

3) ages

4) transmission and incubation

5) contagiousness

6) complications

7) tx

Definition

1) MUMPS - RNA virus

2) time of year - spring

3) ages - 10 to 19 years

4) transmission and incubation - respiratory, incubation 14-25 days

5) contagiousness - 3 days prior to gland swelling, 4-6 days after.  less than measles or varicella.

6) complications: orchitis, oophoritis, meningitis, encephalitis

7) tx - supportive, prevent transmission

Term

fever, lymphadenopathy, maculopapular rash progresses from head to foot, lasts 3 days, itchy.  Rash more prominent after hot shower.

 

1) dx

2) time of year

3) transmission

4) incubation

5) contagiousness

6) tx

7) complications

Definition

1) dx - RUBELLA (third dz, german measles)

RNA virus

 

2) time of year - winter/spring

3) transmission - respiratory

4) incubation - 14 days

5) contagiousness - 7 days before, 5-7 days after rash appears

6) tx - supportive

7) complications - arthralgias, encephalitis, hemorragic disorder uncommon

Term

malaise, fever, generalized pruritic rash of macules papules vesicles and crusted lesions.

1) dx

2) incubation

3) contagiousness

4) transmission

5) tx

6) complications

Definition

1) dx - Varicella (VZV) HHV3.  Chicken pox then zoster.

 

2) incubation - 14 days

3) contagiousness - 2 days before rash through 5 days, or until lesions have crusts

 

4) transmission - resp, direct contact, inhalation vesicular fluid

 

5) tx - supportive, vaccinate

6) complications - 2º infection of skin, peumonia, reyes, meningitis/encephalitis

Term
flu-like sx, fever, joint pain in older children, slapped cheek, lacy reticulated rash on truck/extremities
Definition

Erythema infectiousum, fifths disease

caused by parvovirus B19

 

tx= supportive.  careful during pregnancy.

Term
children ages 6-15 months.  malaise, irritability, URI, high fever first and resolves, then nonitchy rash follows beginning on trunk & spread to arms, neck, NO HEAD/FACE
Definition

roseola infantum - HHV6,7

 

transmitted during respiratory secretions

 

tx supportive

Term

nits 1cm from scalp, firmly attached to hair shaft.  Nocturnal pruritis

 

dx, tx

Definition

Pediculosis Capitis (head lice)

 

whites>>>non whites

 

tx: permethrin (ELIMITE; NIX)

massage into scalp, set 10 min, rinse, fine tooth comb, repeat in 7 days.

CLEAN EVERYTHING.

Term

intesne pruritis, worse at night.  Papules on abdomen, dorsa of hands/feet, elbows, periaxillary skin and interdigital webs.  2º impetigo may be seen, as well as S-shaped burrows.

 

dx, tx

Definition

scabies - 8 legs, live 40 days on human, 2 days off human.

 

Close personal contact to contract.

 

tx: permethrin (ELIMITE) - apply from neck to toes (include head <2y/o), leave overnight. 

Store bedding/clothing for 3 days.

Handwashing.

Term
atopy triad
Definition

asthma, allergic rhinitis, atopic dermatitis (eczema)

 

runs in families

Term
distribution of atopic dermatitis  - infants and children
Definition

infants: extensor surfaces, cheeks, face, trunk

 

children: flexor surfaces of arms and legs

Term

inflammation in the s/f dermis and epidermis characterized by disruption of the skin surface.  heriditary

 

1) dx

2) clinical appearance

3) tx

4) begins at what age, how many have manifestations during adolescence

Definition

1) atopic dermatitis (eczema)

 

2) dry skin, thickened from scratching

 

3) get rid of aggravators, topical steroids, wet dressings, antihistamines.

 

4) begins 1-4 months, few continue into adolescence

Term

contact dermatitis

 

1) majority of cases (80%)

2) tx

Definition

1) majority of cases (80%) - irritant contact dermatitis (acids, solvents, soaps) vs allergic (plants, ABX, latex, cosmetics, metals)

 

2) tx: antihistamines, topical corticosteroids, oral prednisone.

Term

well circumscribes, erythematous pruitic plaques/wheals may be migratory.

 

dx

1) types

2)tx

3) complication

Definition

dx - urticaria

1) types: acute (allergic), chronic (idiopathic, autoimmune)

 

2)tx:PO:  antihistamines, short term corticosteroids

 

3) complication:  immediate attn - angioedema, respiratory stridor/wheezing

Term

oval lesions composed of tiny papules with fine scale, may be itchy.

 

herald patch (single, papular, erythematous lesion enlarging over 1-2 days)

[image][image]

christmas tree distribution

 

1) dx

2) age group

3) tx

Definition

pityriasis rosea

2) teens/ young adults

3) suuportive.  oral antihistamines PRN.  rash may last 6 wks, no therapy will shorten eruption.

Term
DSM IV autism
Definition

Pervasive Developmental Disorders (PDD)

 

unofficially - autistic sprectum disorders (ASD)

Term

Autism

1) appears when

2) what type of disorder

Definition

1) appears by 3 years

2) neurologic disorder and developmental disability - impairments in social interactions, communication, imaginative play

Term
Subtypes of PDD
Definition

Autism

Asperger's

PDD NOS

Rett's Syndrome

Childhood Disintegrative Disorder

Term
Autism Criteria
Definition

6+ items total, including...

 

2+: social impairment

-no multiple nonverbal behaviors (eye contact)

-bad peer relationships

-no sponatenous seeking of enjoyment

-no social/emotional reciprocity

 

1+: communication impairment:

-language delay or none

-inability in sustaining conversation

-repetitive use of language

-lack of varied play


1+: repetitive and stereotyped patterns:

-inflexible and adherent to specific routines

-repetitive movement

-preoccupation with parts of objects

 

ADDITIONAL CRITERIA prior to age 3, delayed in following areas:

1) social interaction

2) language in social communication

3) symbolic/imaginative play

Term

Autism

1) epidemioloy

2) impairments evident by

3) % mental retardation

4) % without useful communication skills

5) % with seizure disorders

Definition

1) 5/10,000, 4:1 males

2) impairments evident by age 3

3) 75% mental retardation

4) 50% without useful communication skills

5) 33% with seizure disorders

Term
early signs of autism
Definition

No smiling by 6 months
No back and forth sharing sounds, smiles, or reciprocal facial expression by 9 months
No babbling, pointing, waving by 12 months
No single words by 16 months
No 2 word phrases by 24 months
Any loss of speech, babbling, or social skills

 

Term
Asperger's vs Autism
Definition
  • no significant delay in language
  • no significant delay in cognitive development, self-help skills, adaptive behavior, curiosity
Term
Asperger's Characteristics
Definition
  • NORMAL intelligence
  • ALL INCOMPASSING interest, which may be developmentally typical or atypical

 

  • personal space
  • motor clumsiness
  • loud noises, clothing, food texture sensitivity
  • volume, intonation, inflection, rhythm of speech off
  • can´t understand others feelings, interpret social cues
  • formal style of speaking, literal interpretation of language
  • innapropriate social responses
  • no give and take of conversations
Term
Autism Screening and Diagnostic Instruments
Definition

Screening: CHAT (toddlers), PDDST

 

Diagnostic Rating Scales

Gilliam, CHildhood, Gilliam Asperger's

Term
overall prevalance of PDD
Definition
1/160
Term
autism treatment
Definition

controversal - chelation, omega-3

 

  • stimulants for hyperactivity - poorly tolerated
  • SSRI for repetitive behavior - fluoxetine
  • SGA for aggression - risperidone
  • Ind Edu Program (IED) for school age kids
  • Speech, OT, PT therapy
  • ABA - applied behavoral analysis to improve social skills and verbalization/communication
Term

Major depressive disorder (MDD)


1. definition and substitute definition for children

Definition

 

     1+ episodes of depressed mood or loss of interest or pleasure for at least 2 weeks with at 4+ depressive symptoms

Change from previous function

In children or adolescents, depressed
mood = IRRITABLE mood

 

Term
Depressive symptoms (SIGECAPS)
Definition

Criteria for MDD= 2+ weeks of 4+ sx:

-Sleep disturbance, hypersomnia or insomnia
-Interests, loss
-Guilt or feelings of worthlessness
-Energy, decreased
-Concentration, poor or indecisive
-Appetite, increased or decreased
-Psychomotor agitation or retardation
-Suicidal ideation

 

Term

Epidemiology of MDD in 

1. Children

2. Adolescents

3. Lifetime prevelence

4. what % go untreated

5. what % will have MDD in adulthood

6.  what is the male to female ratio of MDD in children and adolescents

 

 

 

 

Definition

 

1. 2-4% Children

2. 8% Adolescents

3. 15% Lifetime prevelence

4. 50-75% go untreated

5. 70% will have MDD in adulthood

6.the male to female ratio of MDD in children is 1:1 and adolescents is 1:2

 


WHO predicts deprassion will be the 2nd most burdensome disease by 2020

 

Term

MDD comorbidities

1. Psych-90%

2. Medical

Definition

1. Anxiety;ODD, CD;Substance use; ADHD;Learning disabilities and developmental disorders

2. CA, Pituitary tumors, Thyroid disease, Neurologic disease (esp. migraine), Infection, Hormonal treatments (corticosteroids), CF
Term
MDD risk factors
Definition

 

Genetics/puberty
Life events (loss, failure)
History of abuse
Sexual identity issues  (30% of suicides)
Parenting
Peer environment/changing roles
Poverty 

 

Term
how does MDD present
Definition

 

-—Look sad, move slowly, speak in monotones, restricted affect
-—Describe themselves in negatives; “I am dumb”  “Nobody likes me”  “I am bad”
—-Grades deteriorate
-—Drop out of extra curricular activities, school refusal
-—Somatic complaints; stomachaches and headaches most frequent.  Directly proportional to severity of depression

 

Term
1. MDD presentation in children
Definition

1. Irritable, low frustration tolerance, Failure to thrive, School refusal, phobias, Somatic complaints, Social withdrawal, Little verbalization of depression  

 

2. Hypersomnia, Delusions, High risk activities

Para –suicide and Suicide attempts, Substance abuse, Delinquency  
Term
What is your role as a primary care provider with MDD?
Definition

 

Systematic screening
Clinical identification
Entry level pharmacological intervention (SSRI at moderate dose)
Coordination of other providers (child psychiatrist if available and if needed, psychologist, therapist)
De-stigmatization  - support of treatment adherence for child and especially  foster family acceptance of disease

 

Term
MDD non-pharm treatment
Definition

 

Cognitive behavioral therapy (CBT)
Interpersonal Psychotherapy (IPT)
Education (patient and family)
School and home based help

 

 

Term
MDD pharm treatment
Definition

 

SSRI’s (black box warning)

FDA approved; fluoxetine (Prozac) MDD (>8yo), OCD (>7yo). Taper to d/c.

escitalopram (Lexapro) MDD (>12yo) . Taper to d/c.


CBT may mitigate risk of self harm in initial stages of SSRI treatment. 

 

Term
Antidepressant dosing and precautions
Definition

 

Start with lowest dose, increase slowly
Monitor weekly or biweekly, involve therapist
If partial response increase gradually, if no response, try another SSRI, then SNRI
Ask openly about suicidality along with other SE’s.
Watch for signs of hypomania
Know when to refer to Child and Adolescent Psychiatrist
Must obtain informed consent from parent and adolescent

 

Term

combination of lateral head tilt and rotation deformity of cervical spine.

 

what is this? describe etiologies when seen in infancy and childhood

 

Definition

torticollis

 

infancy - congenital muscular

 

childhood - traumatic rotatory subluxation, Grisel's Syndrome (atlantoaxial rotary subluxation in association w/ pharyngeal infection), neoplasia of brain or C-spine

dx by CT scan if trauma is possible etiology

Term

congenital muscular torticollis characterized by...

 

associated findings...

 

studies...

 

tx...

Definition

contracted sternocleidomastoid muscle (theory: compartement syndrome)

 

associated hip dysplasia (20%), cranial/facial asymmetry

 

studies: C-spine, hip U/S, CT if traumatic etiology

 

tx: stretch! (only if other etiologies ruled out)

surgery: >1yr, cosmetic, limited ROM

Term

scoliosis

 

1) definition

2) etiologies

3) 7º on scoliometer = ? on XRAY

Definition

1) lateral curvature of spine >10º.  DESCRIPTIVE, NOT DIAGNOSIS

 

2) etiologies: idopathic (70% adolescents), neuromuscular, congenital, spinal cord issues/neoplasms

 

3) 20º

Term

poor posture, hips stick out, uneven shoulders

 

skin lesions, differing leg lengths, pain, paresthesias, bowel/bladder sx, L-sided curve

 

 

whats your PE?

Definition

scoliosis

 

PE:

skin, symmetry, gait

 Adams forward bend test - no shirt, lean forward...if prominence, get XRAY-->PA/Lat

 

XRAY may show:

Cobb Angle - a measurement used for evaluation of curves in scoliosis on an AP radiographic projection of the spine  

Risser Sign - how far the patient's iliac apophysis  has progressed from the anterior superior iliac spine.

Term

scoliosis tx

 

when to observe, brace, surgery

Definition

<25º - observe

25-50 - brace

>50º - surgery

 

 

 

Term
when is MRI (rather than radiographs) indicated for scoliosis
Definition
MRI - L sided curve, quick progression, significant pain, neuro findings
Term
Ponseti method
Definition
manipulative technique that corrects congenital clubfoot without invasive surgery.The ligaments, joint capsules, and tendons are stretched under gentle manipulations. A plaster cast is applied after each manipulation to retain the degree of correction and soften the ligaments. long term splinting 2-6 yrs, better outcome if started earlier in life
Term

Congenital failure of segmentation of tarsal bones.

what % bilat?

most common areas?

Definition

Tarsal coalition.

50% bilat.

talocalcaneal and calcaneonavicular.

 

FYI: review of tarsal bones.

[image]

Term
atraumatic ankle pain that is activity dependent, chronic ankle sprains, peroneal spastic/rigid flat foot. Tight hamstrings and subtalar motion with decr ROM. XRAY shows elongated anterior calcaneous process. DX & TX
Definition
coalition presentation. tx: immobilize, stretch, resect
Term
salter harris fractures
Definition

[image]

s - Slipped

A - Above

L - Lower

T - through

R - Rammed

Term
which salter harris do you find normal radiograph
Definition
Type V - compaction of metaphysis on physis causing growth arrest
Term

Fall onto outstretched hand.  Severe pain and can´t move elbow

 

dx and tx and complications

Definition

posterior elbow dislocation

[image]

Reduce then check stability and neurovascular status and get another radiograph to confirm reduction

[image]

complications: most common is intra-articular entrapment of medial epicondyle

Term

annular ligament displacement after forceful longitundinal tractions (UE in slight flexion, pronation, internal rotation)

1) dx

2) common ages

3) tx

 

Definition

1) dx - nursemaids elbow

2) common ages - up to 6 yrs

3) tx - XRAY, no fracture...attempt reduction by supination, hyperflexion, and pressure over lateral aspect of arm.[image]

Term

kids twists knee while running, gets hemarthrosis, and limps away

 

1) dx

2) PE

3) imaging

4) tx

Definition

1) ACL tear

2) Lachman and anterior drawer sign.  Also test varus-valgus stress for collateral ligament tears[image][image]

Lachman                      Ant Drawer

 

3)MRI

4) tx - reconstruction via hamstring graft, bone-patellar-bone graft

Term
child's equivalent of ACL tear
Definition
tibial spine fracture (ACL attached to fragment)
Term

defect of pars interarticularis, L5 -S1 most common

 

1) dx

2) whats it called if there is anterior slippage of L5 on S1 in pediatric pt

3) sign on oblique xray

4) tx for #1 and #2

Definition

1) spondylolysis

2) sponylolisthesis - grade 5 (100% slippage)

3) scotty dog

[image]

4) tx for spondylolysis: restricted activity, PT, brace for comfort, not much progression

 

tx for spondylolisthesis: grades 3+ and neuro findings and deformity...do surgery

Term

 

-degenerative disease of the hip joint

-growth/loss of bone mass leads to collapse of the hip joint and to deformity of the ball of the femur and the surface of the hip socket.

-characterized by idiopathic avascular osteonecrosis of the capital femoral epiphysis

 

1)dx

2) sex

3) ages, ave age

4) unilat or bilat

5) complications

6) 3 s/s

7) tx

 

Definition

Legg-Calve-Perthes Syndrome (LCP)

 

2) sex: male>females

3) ages, ave age: 2-12 (ave 7yr)

4) unilat usually

5) osteoarthritis (DJD) in adulthood

6) 3 s/s: painful limp, limited ROM, weakness

7) tx: maintain ROM, limit progression, surgery

Term

displacement of the proximal femoral epiphysis from the metaphysis

 

1) dx

2) salter harris type

3) sex

4) age

5) unilat or bilat

6) risk factor

7) etiologies

8) presentation

9) labs

10) images

11) complications

12) tx

Definition

Slipped Capital Femoral Epiphysis (SCFE)

 

2) salter harris type I

3) male>female

4) age 12

5)  bilat 30-60%

6) risk factor: obesity

 

7) etiologies: idiopathic, hormonal during growth spurts b/c of weakness (thyroif, gonad, GHT), renal osteodystrophy, radiation therapy

 

8) presentation: limp, thigh/groin pain, knee pain 30% (obturator n.), decr hip int rotation, pain hip ROM

 

9) labs: thyroid, BUN/CR

 

10) XRAY

 

11) complication: AVN if undiagnosed, osteoarthritis

 

12) tx: surgery to prevent any additional slipping of the femoral head until the growth plate closes. If the head is allowed to slip farther, hip motion could be limited. treatment begins within 24 to 48 hours.

Term
limp, thigh/groin pain, knee pain 30% (obturator n.), decr hip int rotation, pain hip ROM
Definition

slipped capital femoral epiphysis

 

salter harris type I of proximal femoral epiphysis.

 

Slipped capital femoral epiphysis (SCFE) is the most common hip abnormality presenting in adolescence and is a primary cause of early osteoarthritis.

 

Term
galleazzi test
Definition
Galeazzi for congenital dislocation/developmental dysplasia of the hip. It is performed by flexing an infant's knees in the supine position so that the ankles touch the buttocks. If the knees are not level then the test is positive, indicating a potential congenital hip malformation.
Term

0-6mos:  asymmetric thigh folds, positive galleazzi, ortolani, and barlow

 

6mos-walking:asymmetric thigh folds, galleazzi, asymmetric abduction

 

 

 

 

Definition
Developmental Dysplasia of the Hip
Term

barlow  and ortolani maneuvers

 

for what age group and for what?

Definition

FOR 0-6 MONTHS.

Barlow = back

Ortolani = abduct

 

POsitive tests = clunk felt and heard =

developmental dysplasia of the hip (DDH)

 

[image]

Term

Child of walking age presents w/ leg length discrepency, painless limp, hyperlordoses, asymmetric abduction

 

1) dx

2) risk factors

3) etiologies

4) diagnostic tests (less than and greater than 6 months)

5) tx and complications (<6 months, <2yrs, >2yrs)

 

Definition

Developmental Dysplasia of the hip (DDH)

 

2) risk factors: beech birth (10x), female (4x), fam hx (4x)

 

3) etiologies:

hormonal (maternal relaxin), dysplasia gene (hyperlaxity, acetabular growth), mechanical, extra-articular (iliopsoas contracture, excess capsular tissue)

 

4) diagnostic tests:

<6month: U/S

>6 months: AP and frog leg lateral

 

5) tx:

<6months: PAVLIK HARNESS 90% effective (100º flex, 50º abduct) x 3month, do U/S in 3 wks.  Complication incl femoral n palsy, AVN

 

6mos-2yrs or failed PAVLIK: closed reducted in OR, cast  3-4 months. Complications: AVN, redisclocation, subluxation

 

>2yrs or failed closed reduction: open reduction

 

 

Term

3 types of rotational deformities that form this....[image]

tx

Definition

femoral anteversion

internal tibial torsion

metatarsus adductus

 

tx: observe

Hips- DDH (Abd <45o),Femoral Anteversion (IR> 45o)
Knee/Ankle – Internal Tibial Torsion (Thigh-Foot Angle <0o)
Ankle/Foot – Metatarsus Adductus (lateral foot border)
Term

correlation of JRA with adult RA

Definition

none

 

Term

altered pain free kinematics, stiffness w/ activity, fatigue, joint warmth, muscle atrophy, joint contracture, growth disturbance (hyperemic physis= increased bld flow)

 

Systemic signs: fever, rash, hepatosplenomegaly, lymphedema, uveitis

 

XRAY shows joint widening early in the process, late stage joint narrowing, periosteal rxn, osteoporosis

 

1) dx

2) labs that support dx

3)tx

4) what % have good prognosis

 

Definition

JRA - dx is mostly clinical

 

labs: CBC shows anemia, leukocytosis, ESR, CRP, ANA

 

tx: preserve strength/ROM, prevent deformity, control pain, extre-skeletal management,

NSAIDS; steroid

 

70-85% good prognosis (not to adulthood)

Term

radiograph shows parallelsim of talus and calcaneus

 

(here's a review of anatomy)

[image]

Definition

Congenital Clubfoot - Congential Talipes Equinovarus

[image]

2/1000

Boys>girls

50% bilat

Term
Loder classification
Definition

Loder classification for Slipped capital femoral epiphysis

 

FYI:

[image]

 

UNSTABLE SCFE: unstable to walk, 50% get AVN


STABLE SCFE: able to walk, good prognosis

Term

AVN of the hip

[image]

1) 3 traumatic etiologies

2) management

Definition

etiologies:

unstable SCFE

hip fx

hip dislocation

 

management:

reconstruction, fusion, replacement

Term
forearm fx of radius and ulna in child - management[image]
Definition

1) radiograph

2) gross realignment

3) NEUROVASCULAR exam

4) send to specialist for reduction

5) closed reduction and cast 95% effective (open reduction for plates and screws)

Term
Gustilo-Anderson Classification of Open Fractures
Definition
TypeWound DescriptionOther Criteria

 

I

 

<1 cm (so-called puncture wounds)

 

 

II

 

1-10 cm

 

 

IIIA

 

>10 cm, skin coverage available

 

Segmental fractures, farm injuries,or any injury occurring in a highly contaminated environment
High-velocity gunshot injuries

 

IIIB

 

10 cm, requiring soft tissue coverage procedure

 

Periosteal stripping

 

IIIC

 

 

With vascular injury requiring repair

Term
open fx tx
Definition

IV ABX 24-48 hrs beginning immediately:

cephalosporin + aminoglycoside for contamination + PCN for farm injury

 

tetanus

 

irrigation/debridement non-viable tissue

 

stabilize/immobilize

 

wound closure/bone coverage

Term
Saltar Harris I dislocated fx of Distal Femur without pulse or perfusion warrents what PE and management?
Definition

1)PE:

Neurovascular exam:

-pulse

-cap refill

-Ankle Brachial Index (ABI)

-sensory and motor

 

2) Fracture reduction in OR, then wait 10-15 minutes for spasm to resolve

 

3) open site, inspect popliteal a., do on table arteriogram and vascular repair

Term

kid falls on her head during chearleading, she has burning in all extremities and inability to move extremities.

 

dx and management

Definition

CERVICAL CORD NEURAPRAXIA

 

1) ABCs and spine stabilization to ER

2) Neuro exam

3) imaging C-spine & full spine MRI

 

****exam is normal usually 10 minutes after trauma, all imaging is normal. The mechanism is thought to be due to brief compression of the spinal cord resulting in transient interruption of the spinal pathways.***

Term
On  C-spine, what is diagnostic of cervical stenosis
Definition

Torg ratio <0.80


torg ratio= diameter of cervical canal : to width of cervical body

 

**athletes with cervical cord neurapraxia (CCN) have torgue ratio      < 0.80**

 


Term
when is return to play permitted?
Definition

normal MRI and exam

 

no previous CCN

Term

 

 

Depression Scale For Children (CES-DC)

 

Definition

 Depression Scale For Children (CES-DC)

 screening tool

higher the score, more depressed.

scale 0-60

score >15 = suggestive of depression

Term

2 y/o presents with barking cough and respiratory distress, worsening at night and improving in the morning. kid had recent URI.  PE reveals inspiratory stridor

+/- rales, diminished breath sounds (atelectasis), fever (50%)

 

1) dx and age group

2) etiology

3) pathophysiology

4) studies

5) tx

Definition

1) dx= CROUP: 6mos-3yrs

 

2) etiology: parainfluenza virus type I, other: RSV, influenza A&B, adenovirus, enterovirus, rhinovirus, measles, M. pneumoniae

 

3) pathophysiology - acute inflammation of upper and lower respiratory tracts.  Atelectasis if bronchioles become obstructed.

 

4) studies - AP neck/chest xray show subepiglottic narrowing, but dx is usually clinical

 

5) tx is supportive. 

lasts 3-4 days, resolves spontaneously. 

HYDRATE 

antipyretics.

cool humidified air

PO dexamethasone (corticosteroids)

racemic epinephrine

Term

3 y/o presents with sudden onset of sore throat and high fever.  ASsociated dysphagia, drooling, inspiritary stridor.  Pt is sitting, leaning forward, w/ hyperextended neck and mouth open.

 

1) dx

2) age group

3) etiology

4) management

5) tx

 

Definition

EPIGLOTTITIS

 

-2 to 5 years

-H. Influenza type B in unvaccinated kids

- ADMIT ASAP, neck XRAY, flexible fibroscopic laryngoscopy

-NASOTRACHEAL tube to secure airway, IV ABX

**prevent w/ vaccine**

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