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NR602 Midterm

Terms in this set (108)

What is a chalazion?
Benign, chronic lipogranulomatous inflammation of the eyelid
What causes a chalazion?
Blockage of the meibomian gland
What puts a person at risk for a chalazion?
Hordeolum or any condition which may impede flow through the meibomian gland.

Mite species that reside in lash follicles.
What are physical exam findings for a chalazion?
Painless
Does NOT involve lashes
Lid edema or palpable mass
Red or grey mass on inner aspect of lid margin
What is prevention for chalazion?
Good eye hygiene
What is treatment for chalazion?
Warm, moist compresses 3x a day
If secondarily infected: sulfacetamide or erythromycin
What is the follow-up for chalazion?
In 2-4 weeks
If still present after 6wks, follow up w/ophthalmologist
What is blepharitis?
Inflammation/infection of the lid margins (chronic problem)
What are the two types of blepharitis?
Seborrheic (non-ulcerative)
Ulcerative
What can cause seborrheic blepharitis?
Irritants (smoke, makeup, chemicals)
What are s/s of seborrheic blepharitis?
Chronic inflammation of eyelid
Erythema
Greasy scaling of anterior eyelid
Loss of eyelashes
Seborrheic dermatitis of eyebrows/scalp
What usually causes ulcerative blepharitis?
Infection w/staph or strep
What are s/s of ulcerative blepharitis?
Itching
Tearing
Recurrent styes
Chalazia
Photophobia
Small ulceration at eyelid margin
Broken/absent eyelashes
Most frequent complaint: ongoing eye irritation, conjunctiva redness
What is the treatment for blepharitis?
Clean w/baby shampoo 2-4 times/day
Warm compresses
Lid massage (right after warm massage)
How are infected eyelids with blepharitis treated?
Antistaph abx: bacitracin, erythromycin 0.05% x1 wk and quinolone ointments
How is blepharitis infection resistant to topical abx treated?
Tetracycline 250mg PO x4
Doxy 100mg PO x2
What is conjunctivitis?
Inflammation or irritation of conjunctiva
What is the most common cause of conjunctivitis in peds?
Bacteria
What are some common causes of bacterial conjunctivitis?
Contact lenses
Rubbing eyes
Trauma
What are s/s of bacterial conjunctivitis?
Purulent (green/yellow) drainage, initially unilateral, then bilat

Sensation of FB is common

Redness

Crust/matted eyelids in AM
How long does bacterial conjunctivitis usually last?
5-7 days (self-limiting)
What is the treatment for bacterial conjunctivitis?
Eye drops: polytrim, erythromycin, tobramycin, cipro
What is the most common organism causing bacterial conjunctivitis?
H. influenza
What are common causative organisms of viral conjunctivitis?
Adenovirus
Coxsackie
Herpes
Molluscum
What are s/s of viral conjunctivitis?
Profuse tearing
Mucus drainage
Burning
Concurrent URI
Enlarged/tender preauricular nodes
What is treatment for viral conjunctivitis?
Antihistamine
Decongestant
How long does viral conjunctivitis usually last?
7-14 days (self-limiting)
What is the cause of chlamydial conjunctivitis?
Chlamydial trachomatis
What are s/s of chlamydial conjunctivitis?
Profuse exudate

Associated w/GU s/s 1-2wks after birth
When does gonococcal conjunctivitis usually occur?
2-4d after birth
What is the biggest concern with gonococcal conjunctivitis?
Can cause blindness
What is the treatment for chlamydial conjunctivitis?
PO azithromycin, doxy (tetracyclines increase photosensitivity, don't use in pregnancy)
When does chlamydial conjunctivitis usually improve?
2-3wks
What causes allergic conjunctivitis?
IgE mast cell reaction
Environmental
Cosmetics
What are s/s of allergic conjunctivitis?
Marked conjunctival edema
Severe itching
Tearing
Sneezing
How is allergic conjunctivitis treated?
Topical antihistamine or topical steroids
When is improvement usually seen in allergic conjunctivitis?
2-3 days
How is chemical conjunctivitis treated?
Thimerosal
Erythromycin
Silver nitrate
What are s/s of chemical conjunctivitis?
Conjunctival erythema
Conjunctivitis never accompanies _______________ ________________.
Vision changes
When is ophthalmology referral necessary for conjunctivitis?
Herpes
Hemorrhagic
Ulcerations
When can a pt return to work/school with conjunctivitis?
24h after topical abx
What is hand foot mouth?
Highly contagious viral illness, most common in kids <5
What is the most common cause of HFM?
Coxsackie A 16
What are s/s of HFM?
Fever

Vesicular eruptions in oropharynx that may ulcerate

Maculopapular rash involving hands & feet

Rash evolves into vesicles, esp. on dorsa of hands/feet

Lesions on buccal mucosa, palate, palms/soles, buttocks

Malaise

Abd pain

Enlarged anterior cervical/submandibular nodes
How long does HFM usually last?
1-2wks
When does the exanthem of HFM occur?
Usually 1-2 days after oral lesions
What are some differentials for HFM?
Herpangina
Stevens-Johnson syndrome
What is the treatment for HFM?
Maintain hydration
Cool liquids
Avoid spicy food
Rest
Topical aluminum hydroxide/mag hydroxide gel w/diphenhydramine applied to painful lesions
Topical anesthetics: Kank A, Orabase
What is strep pharyngitis?
Acute inflammation of pharynx/tonsils, associated w/crowding (like school, daycare)
What are s/s of viral pharyngitis?
Red/swollen tonsils
Red/swollen throat
Cough (almost always excludes Strep)
Conjunctivitis
Nasal congestion
Diarrhea
What are s/s of bacterial pharyngitis?
Swollen uvula
White spots
Red/swollen tonsils
Red/swollen throat
Gray, furry tongue
What commonly causes viral pharyngitis?
Rhinovirus
Adenovirus
Parainfluenza
Epstein-barr virus
What commonly causes bacterial pharyngitis?
Group A strep
What increases the risk of getting pharyngitis?
Fam h/o rheumatic fever
Day care
What are s/s of strep throat?
Cervical adenopathy
Fever >102
No cough/nasal congestion
Petechiae on soft palate
Beefy red tonsils
Sandpaper rash (nose, neck, torso)
Abd pain
HA
What are some diagnostic tests for pharyngitis?
Rapid strep
CBC (WBC shift to the left)
Monospot if mono suspected
What are some treatments for pharyngitis?
Gargle with salt water
Change toothbrush
PCN x1 IM or x10d PO
1st gen cephs x10d
Azithro (if PCN)
What is the incubation period for pharyngitis?
2-5d
When is a consult/referral needed for pharyngitis?
Evidence of acute renal failure
Reddish, tea colored urine (2-3w post-infection)
When is a pt no longer contagious with pharyngitis?
After 24h on abx
What is kawasaki dz?
Acute, febrile, immune-mediated, self-limited dz characterized by vasculitis.

Leading cause of acquired heart dz in kids.

85% <5yo

Most prevalent in Japan
What is diagnostic criteria for Kawasaki dz?
Requires 5d of fever plus >/= 4 of the following:

-Bilat bulbar conjunctival injection
-Oral mucus membrane changes (injected/fissured lips, injected pharynx, strawberry tongue)
-Periph extrem. changes (erythema of palms/soles, edema of hands/feet, periungual)
-Polymorphous rash
-Cervical lymphad. (>/= 1 lymph node >1.5cm in diam)
What is stage 1 of Kawasaki dz?
Acute (1-2w):
-High fever 103-105 x5d unresponsive to abx
-Oral mucosa lesions may last 1-2w
-Perineal rash
-Non-tender cervical lymphad.
-Painful rash/edema on feet
What is stage 2 of Kawasaki dz?
Subacute (2-8w after onset, without treatment):
-Desquamation of palms, feet, periungual area
-Coronary artery aneurysm
-Joint aches/pains
-Acute MI
-Pancarditis
-Diarrhea
-Jaundice
-Hepatosplenomegaly
-Plt count >10,000,000/mm
What is stage 3 of Kawasaki dz?
Convalescent:
-Clinical signs resolved
-Completed when all labs return to normal
-Nail changes (Beau lines: deep transverse grooves across nails)
What are some differentials for Kawasaki dz?
Group A strep
Scarlet fever
Measles
Epstein barr
Toxic shock
Rocky mountain spotted fever
Stevens-Johnson syndrome
Juvenile RA
What are some tests for Kawasaki dz?
CBC (anemia, plt 50% >450K)
ESR >100
CRP
EKG (prolonged PR, decreased QRS)
CXR (dilated heart, pleural effusion)
Pyuria/mild proteinuria
What is the pharm treatment for Kawasaki dz?
IVIG single dose 2g/kg over 12h in first 10d
ASA 80-100mg/kg/d in 4 doses
What are some complications of Kawasaki?
MI
Development/rupture of coronary artery aneurysm (may cause emboli, HF, heart valve probs, dysrhythmia, myocarditis)
What is rheumatic fever?
Inflammatory dz that develops in 1-3% of kids who have untreated group A strep.
What all can rheumatic fever affect?
Heart
Blood vessels
Joints
Skin
CNS
Connective tissues
What are s/s of rheumatic fever?
h/o pharyngitis 2-4 prior to symptom onset
Modified Jones criteria to dx:
J: joints (polyarthritis)
O: carditis
N: nodules
E: erythema marginatum
S: sydenham's chorea

Minor criteria: fever, esr, arthralgia, long PR interval
What are some tests for rheumatic fever?
Throat cultures
Negative antigen test
ESR
CRP
ASO titers
EKG
CXR
CBC
What is treatment for rheumatic fever?
First line: PCN

If allergic to PCN: azithro

Prednisone
ASA
No prophylaxis for endocarditis in rheumatic fever
What is milia?
Superficial cysts filled with keratin: white papules found on forehead, face, chin, cheeks
Usually in infants (disappear few wks after birth, may appear on palate)
1-2mm
What is a port-wine stain?
AKA nevus flammeus

Permanent defect that grows w/child
If forehead and eyelids are involved, potential for multiple symptoms (Sturge-Weber, Klippel-Trenaunay-Weber and Parkes Weber)
What is a salmon patch?
AKA stork bite at base of neck, angel kiss between eyes

Simple nests of blood vessels that fade after a few weeks or months.

Occasionally stork bites don't fade

No treatment needed
What are cafe au lait spots?
Smooth, regular borders of darkened patch
If a child has >5 cafe au lait spots that are >1.5cm, what should be suspected?
Possible Von Recklinghausen's dz (90-100%)

LEOPARD syndrome:
-Lentigines
-Electrographic abnormalities
-Ocular hypertelorism
-Pulmonary stenosis
-Abnormalities of genitalia
-Retardation of growth
-Deafness
In kids <5yo with 5 or more cafe au lait spots of at least 0.5cm, what should be suspected?
Neurofibromatosis
What is a rare but diagnostic sign of neurofibromatosis?
Smaller 1-4cm diameter cafe au lait spots in axillae (axillary freckling or Crow's sign)
What is a hemangioma?
Dilation of capillaries
Raised
Cavernous
Appear bluish
Located deep beneath skin
NOT present at birth, appear w/in few months, disappear before 10yo)
What is a strawberry hemangioma?
Bright red vascular overgrowth
Elevated
Vary in size
What is a possible treatment for strawberry hemangioma?
Steroids
What is impetigo?
Superficial infection of skin that begins as small superficial vesicles that rupture/form honey colored crust

Usually 2-5yo
What causes bullous impetigo?
Staph aureus or group A strep
What causes non-bullous impetigo?
MRSA
What does non-bullous impetigo look like?
1-2mm vesicles that rupture/form honey-colored crusts
Weeping, shallow, red ulcers
Common on mouth, face, nose, site of insect bites
What are some treatments for impetigo?
Good hygiene
Hand washing
Mupirocin (Bactroban) TID
Retapamulin (Altabax) BID
1st gen ceph for large area (No Pcn? Consider macrolide)
How long before impetigo usually resolves?
7-10d
What is molluscum contagiosum?
Infection caused by poxvirus, resulting in benign, mild skin dz characterized by lesions (growths), can appear anywhere on body.
How long does it take molluscum to resolve?
Usually 6-12mo, but can take as long as 4yrs
What do molluscum lesions looks like?
Small, raised, usually white, pink, or flesh-colored w/dimple or pit in center.

Often have pearly appearance.

Usually smooth, firm.

Usually about size of a pinhead to as large as a pencil eraser.

May bit itchy, sore, red, or swollen.
Where is molluscum usually NOT found?
Rarely on palms/soles
How is molluscum spread?
Direct person-to-person physical contact and through contaminated fomites
What are fomites?
Inanimate objects that can become contaminated w/virus
What is the treatment for molluscum?
Because it is self-limited in healthy people, tx may be unneccessary.

Tx options: iodine & salicylic acid, potassium hydroxide, tretinoin, cantharidin
What is verruca vulgaris?
Wart: painless, benign skin tumor, viral (HPV 6 or ll)
What are the characteristics of the common wart?
Rough surface
Elevated
Flesh-colored
What is the treatment for warts?
Paring & debridement of wart prior to any treatment.

Soak in warm water, occlude w/waterproof tape x1wk, leave open to air 8-12hrs, then reocclude x1wk

Cryotherapy w/liquid nitrogen (5sec freeze until ice ball forms)
When should a biopsy be done on a wart?
When it is resistant to therapy.
What is herpetic whitlow?
Swollen, painful lesion w/erythematous base/ulceration resembling paronychia
Where does herpetic whitlow usually occur?
Finger or thumb of thumb-sucking kids w/gingivostomatitis or adolescents w/genital HSV infection
How long are herpetic whitlow lesions contagious?
As long as they are present

Incubation period 2-12d
What are s/s of herpetic whitlow?
Primary herpes
Fever
Malaise
Sore throat
Decrease fluid intake
Deep-appearing vesicles on fingers
What are some diagnostic studies for herpetic whitlow?
Tzanck smear on fluid from lesions to ID epidermal giant cells, but doesn't distinguish HSV-1 from HSV-2
What is the gold standard for diagnosing herpetic whitlow?
Viral cultures
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