Peds Quiz 1 (copy)

Teratogens

- Any agent that can harm an embryo or fetus
- Usually happens before nurse meets patient
- Appearance of anomalies and/or developmental defects due to exposure to a teratogenic agent during fetal development
- Most serious when structure is forming
- All teratogens do the worst work during structural development of heart, brain, liver, etc. Most happen during early pregnancy

Examples of teratogens

Agrochemicals, alcohol, psych meds, antihypertensive medications, retinoids, recreational drugs, methamphetamines, marijuana, rubella, cytomegalovirus

Agrochemicals

- usually pesticides
- affect developmental structures of baby if pregnant person is exposed
- Strawberries have a lot of pesticides, can affect heart development of baby

Alcohol

- Toxic, can have fetal alcohol spectrum disorder depending on amount of alcohol fetus is exposed to. - Especially early weeks of pregnancy and drinking.
- physical and cognitive impairments.
- Safe amount of drinking for pregnant person is 0

Psych Meds

- Dilantin (seizure meds) - passes through maternal circulation through placenta and inhibits brain development

Anti-hypertensive medications

- ACE inhibitors, beta blockers.
- Causes other body and circulatory changes
- Play balancing game, need more but not too much
- BP is too high = fragile developing blood vessels of fetus can burst open, circulation can be messed up and prevent oxygen and blood from getting to baby

Retinoids

- Vitamin A, accutane
- Inhibits development of fetus' liver

Marijuana

- Child has significant attention problems, hard to pay attention
- Has a hard time working, influences memory capabilities

Methamphetamines

- Affects electrical activity of heart
- Heartbeat is uncoordinated
- Cannot respond to ____ metabolic needs
- Born w/addiction

Neonatal abstinence syndrome

Baby is crying, hard to feed bc _______, skin is very thin, getting infection, little immune process to protect themselves

Immature GI system (NEC)

GI develops later bc need other organs more
- Pancreas regulates nutrition, so don't need GI system until later, spend more time making heart.
- Born early = no more maternal circulation, need to absorb food to get circulation

Necrotizing Enterocolitis

- Necrosis due to inflammation of the small and large intestine
- Portion of the bowel undergoes necrosis
- Interrelationship among: ischemia, immaturity, infection, immunity, and nutrition
- can't drink, can't eat, dehydrated
- Most common GI disorder in premature infants
- Most common surgical emergency in neonatal period
- Can lead to short bowel syndrome

What happens in necrotizing enterocolitis?

- GI and blood flow to GI develops late
- Blood supply normally goes to large and small intestine, supplies to the wall and secretes mucus so GI tract is lined and acts as a lubricant to prevent obstruction. Has enzymes that break down food eaten and allows for nutritional absorption.
- Baby is born before blood supply is adequate, not enough nutrients and now GI has not lubricant and protection from enzymes.
- Enzymes break down tissue of intestines -> inflammation -> signal is sent to draw in bacteria that has affinity for inflammation. Bacteria colonize and produce gas (a lot) -> baby feels bad, abdominal distension b/c gas buildup (can look through skin and see loops of intestine but inflate so much -> intestine burst, perforation of intestine -> non-sterile of intestine enters sterile peritoneal -> peritonitis -> bad immune system and turns into sepsis

Clinical Presentation of NEC

- Abdominal Distension
- Visible bowel loops
- Bloody stool / Heme positive stool (b/c little blood supply, GI bleed b/c eroded)
- Feeding intolerance: hard to feed b/c inflammatory process, if strong enough body will reject anything going in GI. If does an NG tube, just filling up stomach, will fill and lead to emesis -> choking
- Increased residual
- +/- bilious vomiting : green = bile from gallbladder to small intestine to remove fat and moves to large intestine to remove. If in vomit it will go the other way around and will now vomit, this happens if there is an obstruction downstream, which can be due to inflammation
- Lethargy: no nutrients or energy
- Apnea, bradycardia, oxygen desaturation - ask!
- Blood glucose instability: fuels our processes
- Temperature instability: 96-104 is when we function, when too low or high metabolic process doesn't work very well. Have a hard time getting out of it

Management of NEC

- Stop all feedings b/c can't absorb
- Aggressive IV fluid/electrolyte replacement (IV nutrition and fluid)
- Ventilation by ETT if in respiratory failure - ask!
- NG decompression (critical) and early TPN: remove gas to prevent perforation of intestine, NG is escape for gas but if not working needs to be NJ, to small intestine b/c where gas really is
- Broad spectrum antibiotics: infective process but premature baby = liver is not mature, only have 3 antibiotics for babies, need to watch labs and see if effective
- Pain control and minimal handling
- Serial abdominal x-rays and frequent labs
- Surgery: if not corrected using above, part of intestine is cut out b/c necrotic and then joined together, now kid has short bowel (short bowel syndrome), less distance of bowel = harder to collect all nutrition needed, work with dietician

What are the 3 antibiotics used in babies?

Ampicillin, Gentamycin, and Clindamycin

Newborn screening

Every state mandates, CA has 4 conditions
- Phenylketonuria (PKU)
- Congenital Hypothyroidism
- Galactosemia
- Hemoglobin Defects (sickle cell disease)
- Blood is collected by heel stick: put heel warmer on kid, heat causes vasodilation, poke shaded areas b/c blood supply is good and sensory nerves are minimal. lancet, want to take it once, put drops on each circle

Phenylketouria (PKU)

Autosomal recessive metabolic genetic disorder caused by the mutation of the gene required to metabolize the amino acid phenylalanine, which gets built up
- Accumulation leads to severe cognitive impairment, behavior issues; lose grey and white matter and myelin, start to slow down or lose connection
- Both parents contribute gene
- Child for the rest of their life needs food w/ very low or no phenylalanine or else have severe cog impairment. Can stop before start

Phenylketouria treatment

- Foods with a lot of phenylalanine: Meats, dairy products, artificial sweeteners
- Breast milk some phenylalanine; if want to breast feed, will try but child comes in every week to see levels. Don't want high levels b/c start to demyelinate, some will stop breastfeeding, etc.

Congenital Hypothyroidism

- CH is a common, preventable cause of cognitive impairment
- Present at beginning, thyroid is underactive, thyroid hormone drive metabolic processes, not operate at level need to.
- Most accurate if wait 3-4 days, done with day 1-2, do early can have a false positive but if we get it, they need to come back.

Symptoms of congenital hypothyroidism

- Low T4, TSH
- Quiet, good baby: baby never cries, always seems goof but is b/c of hypothyroid
- Prolonged jaundice: juandice b/c metabolic process that fuels liver activity is so slow
- Lethargy
- poor appetite: hard to feed
- VS changes: HR is slow, temp, rr, and bp is low
- macroglossia: enlarged tongue

BAD AND LEADS TO COGNITIVE IMPAIRMENT

Treatment of congenital hypothyroidism

- Start treatment immediately
- Inadequate treatment = fatigue
- Sleepy, decreased appetite, constipation, cognitive impairment
- Thyroid replacement therapy: synthroid, levothyroxine, taken for rest of life, child develops normally
- wait 3 months b4 replacement therapy, IQ average is max 89 (normal is 100), 6 months = 81, 9 months = low seventies, can't talk, eat by themselves, go to bathroom by themselves

Galactosemia

- Deficiency in hepatic enzymes involved in the conversion of galactose to glucose
- Normal at birth then....
- Child is eating well but not gaining weight and growing. Not meeting metabolic demand of body
- Identify enzyme in liver that is lacking -> can't convert galactose to glucose. No energy process fueled to grow and develop. Switch energy source in food to soy formula. Can grow and develop normally and reach full potential.

Hemoglobin Defects

- Screening is mandatory
- Prophylactic abx: penicillin and these kids take everyday of their life
- Educate to recognize early signs of infection
- Can't prevent this but can minimize effects
- Under certain conditions (triggers) -> sickle or crescent moon shape = fever caused by infection that trigger sickle
- Start child on preventative abx to prevent fever and infection to prevent trigger of sickle

Cleft lip and palate

- May or may not be diagnosed prenatally
- Genetics, teratogens, folate deficiency, or isolated incident

Cleft lip and palate surgery

- Covered by insurance b/c has functional aspects not just cosmetics
- Cleft lip repair usually 2-3 months (rule of tens... weeks, pounds, hemoglobin). Adaptations done after 2-3 months, not life threatening so not rushed to OR when had it, also GA for newborns is not ideal
- Cleft palate repair completed before 12 months, sometimes in stages. If close too soon, upper teeth come out and go sideways, teeth won't meet and breakdown food, do need to close so can say words
- Associated problems: orthodontic, speech, hearing, OM
- Only palate and not lip: can't lay baby down and feed has to be upright bc then only some would go down, esophagus, some just go into cleft, upright, things go down, and help baby swallow

Feeding Challenges

- Longer and softer nipples: can push nipple up to close cap and close gap for negative pressure
- X or Y nipples: slit cute into nipples so takes less negative pressure
- Squeezable bottle: skills to learn how much should be squished so not exhausted from just sucking and not choking
- NG or GT for insufficient PO intake
- Blister on wrist b/c sometimes in utero will suck on wrist. Hold baby in certain way for breastfeeding w/ cleft palate, can also pump breast milk and put in bottle
- put ng tube when sleep
- Besides appearance is not life threatening, feeding is a challenge, sucking reflex from milk/breast, cleft or gap prevents them from putting lips around nipple to be able to suck, can't create negative pressure.

Clinical Considerations of cleft lip

- Multidisciplinary care, psychosocial implications
- Post-op challenges:
- Airway, suture line, and feeding issues
- Pain management to limit crying, elbow restraints (ROM)
- At risk for hearing loss, early screening w/ AABR (Automated Auditory Brainstem Response), headphones that can pick up electrodes if brain picks up sound

- relisten and read top part

Cerebral Palsy

- A non-progressive (permanent) disorder of the developing brain
- May present at birth or evident in infancy/early childhood
- Movement disorder, all muscles try to overpower each other -> shaking and not moving. Brain isn't able to inhibit opposing signals -> locked movement position.
- Spastic cerebral palsy b/c muscles are spastic and fighting each other

Potential associated deficits of cerebral palsy

- Seizures
- Visual/hearing disturbances
- Attention/behavioral
- Communication and speech, often part
- Cognitive and/or motor: some are high intelligence but can have severe cognitive effects, muscles used to speak are engaging to speak, diaphragm, muscles of upper face. but if dif muscles engaged at the same time hard to do, lead to speech therapy

CP Risk Factor

- Birth asphyxia: not enough O2 at birth
- Malformations of the brain: from teratogen, other reasons
- Intrauterine infection: cytomegalovirus perhaps
- PRETERM INFANT
- VERY LOW BIRTH WEIGHT (most important)

CP Diagnosis

- Sometimes diagnosed at birth, sometimes takes long to manifest
- Baby can feel stiff
- Neuro exam
- History
- Posture/tone: see posture, muscle tone (hypotonicity), muscles all engaged, can't relax b/c muscle group
- Persistence of primitive reflexes
- MRI: MRI of brain to make sure no tumor or malformation that can be corrected

Scissor Gait

Not a lot of muscles in anterior/ muscles in upper thighs don't have a lot of opposition, so can try to walk
- some can't do this

Cerebral Palsy Management

- Team Approach
- Maximize motor function, ADL's: appropriate to age
- AFO's (Ankle Foot Orthosis): to get heel and foot down and pointed forward, best for gait
- Enhance communication: speech therapist
- Bracing, casting, surgery: put cast so won't remove, if both not work can get dorsal rhizotomy (root of nerves that stimulate muscles are cut, signal no longer there, don't cut too much or else signal no longer there)
- Meds (decrease spasticity): prevent activity to be able to get control, pump into intercostals where CSF, slows neurons that fire to relax and get control
- Nutritional assistance: complicated swallowing, aspiration, NG tube
- Family support (have to support parents too)

Spina Bifida

- A deformity/defect of the spine that includes several injuries with different severity and prognosis
- Spine done during 5-9th week of gestation, if not closed by then, it won't close.
- Sometimes due to folate deficiency
- Split/opening

Consequences of spina bifida

- Paralysis
- Neurogenic bowel/bladder
- Hydrocephalus
- Ortho abnormalities

3 types of spina bifida

Spina bifida occulta
Meningocele
Myelomeningocele

Spina Bifida Occulta

- Hidden/ cannot see
- Lack of closing of the spine
- Not too devastating functionally but is vulnerable to _____

Meningocele

- Sac
- Meninges = cover of nervous system
- Means meninges tissue in sac. Innervation is fine but going down can have some paralysis

Myelomeningocele

Meningio tissue in sac, myelin sheath cover of tissue = in sac too. Everything there and down is not functional at all. Legs have muscles but no nerve connection. Innervation of bowel and bladder -> filling but no simulation to pee, no control/peristalsis, pee starts to spill

Pre-op of spina bifida

- Baby born by c-section b/c birth canal will tear open. Nurse hold baby prone, go into NICU
- cover sac w/ moist sterile dressing to prevent infection
- be mindful of thermoregulation: radiant heat warmer, will also dry out dressing so need to keep moist b/c don't want meningocyle to crack open
- No pressure over affected area
- Antibiotics, IV fluid
- Latex precautions: assume have allergy b/c almost all do

Post-op of Spina bifida

- Prone for 7 days. Then on sides but not supine
- Can't pick up baby for a week, can sit next to them, sing, touch scalp, let them know parent is there
- Foley progresses to intermittent catheterizing: to help empty bladder
- Protect incision from stool and urine
- Observe for leaks: water on dressing, tell neurosurgeon b/c problems since CSF
- Administer antibiotics
- Daily head circumference and weekly head ultrasounds
- Meds: Urecholine to reduce urinary retention and colace to soften stool
- Long term care: don't know outcome of surgery for years, need to see walk and stand, bowel training.

Latex Allergy

- Don't use latex gloves, especially spina bifida patients
- Can be local reaction
- Can be severe, anaphylactic reaction: life-threatening especially in kids with myelomenigocele

Esophageal atresia

Esophagus has no connection to stomach, milk goes back up and into lungs -> coughing
- The esophagus terminates into a blind pouch

The 3 C's of esophageal atresia

- cough
- choking
- cyanosis

Tracheoesophageal fistula

- Distal segment attached to the trachea
- Distal end of esophagus is hooked to trachea, need to stop feed b/c will lead to aspiration

How to treat esophageal atresia and tracheoesophageal fistula

- No oral intake
- Need to put in IV, give fluid and electrolytes
- Needs corrective surgery but some too young for surgery
- Need to start TPN b/c need nutrition while wait
- Need surgery to do end to end anastomosis
- May need stoma in neck and GT feeds until repair is done

Erikson's Stages of Personality Development

- Common tasks of being a person
- Positive and negative outcomes to each stage, form fairly solid resolution for each stage, but never fully solid
- never complete, only have some resolution

What are the different stages of psychosocial development?

- Infant: Trust vs. Mistrust
- Toddler: Autonomy vs. Shame and Doubt
- Pre-schooler: Initiative vs. Guilt
- Grade-schooler: Industry vs. Inferiority
- Teenager: Identity vs. Role Confusion
- Young Adult: Intimacy vs. Isolation
- Middle Aged Adult: Generativity vs Stagnation
- Older Adult: Integrity vs. Despair

Infant: Trust vs. Mistrust

- Needs need to be met consistently to be able to trust parent
- 1-1.5 years - if feel like can trust will feel free to explore b/c has a safe place to go back to
- If cry a lot before feed/change diaper/not consoled -> mistrust and suspicion, can't explore world.
- As 1 year old, stress hormones rise -> increased cardiac and mental problems

Toddler: Autonomy vs. Shame and Doubt

- Connected to potty
- Realize they are their own person and can control things in body
- Autonomy brings control and responsibility
- Has to control bladder, if child does well, feels good and sense of self confidence and self
- Bad = shame = feel bad for the person you are and sense of unworthiness

Pre-schooler: Initiative vs. Guilt

- Autonomous and can make decisions, do things, control body too
- Kids needs to explore and have to do in safe parameters, can't be too strict
- Seemingly insignificant is world to kid (?)
- Cause positive sense of self if allowed to explore
- Negative is seen as like a bad kid, feel like bad person who does bad things

Pre-schooler: Initiative vs. Guilt

- Magical thinking and imaginary friends; curious about
- Belief that thoughts are all powerful
- Need to assert control over the environment by taking initiative, planning activities, accomplishing tasks
- Caregivers need to encourage exploration and to help kids make appropriate choices
- Child unclear of cause/effect (vomiting causes them to get sick, rather than other way around), figure out how life works

Grade-schooler: Industry vs. Inferiority

- Industry: Can do things, good at stuff, subjects, games, popular
- Inferiority: Not good at stuff, develop sense of inferior and is hard to shake, feel lonely and feel like people don't like them

Teenager: Identity vs. Role Confusion

- What am I, what do I want to become
- Keep values grew up with or no?
- + = good resolution of self and place in world
- - = role confusion, doesn't know what to do

Young Adult: Intimacy vs. Isolation

- 20 - 40
- Forming lifelong intimate relationships with people or live in isolation

Middle Aged Adult: Generativity vs Stagnation

- Am I still growing?
- Contributing something to life or just doing the same thing and waiting to retire

Older Adult: Integrity vs. Despair

- Look at life you have and happy with it or not? Happy with values that matter? Death worth being alive for?

What did Piaget believe about intelligence?

- Intelligence increases possibility of survival and flourish in life
- Intelligence is a form of adaptation wherein knowledge is constructed by each individual through the two complementary processes of assimilation and accommodation
- Dif types of intelligence slide 10

Cognitive Development by Piaget

- Birth - 2 years: Sensorimotor
- 2 - 7 years: Preoperational
- 7 - 12 years: Concrete operational
- 12 years + : Formal operational

Birth - 2 years: Sensorimotor

- Understands world through senses and actions
- Born with reflexes
- Reflexes start to fade and then turn into conscious decisions, conscious control
- Senses are exploration tool here but as we move on we have representational thought, doesn't need to be feasable to think about
- if kid doesn't sense presence then no longer exists
- no object permanence

2 - 7 years: Pre-operational

- Understands world through language and mental images
- sounds we give meaning, dependence on each other
- Associates sound with name, language development
- nouns then verbs then adjectives
- maturity of representational thought
- have object permanence, volume/perception. things can be same even though they appear different, can be dif even if appear the same
- egocentric
- enter elementary school -> go beyond egocentric
- in school kids can't go past egocentrism or what it would feel like to be someone else
- Goal: move past ego centrism

7 - 12 years: Concrete operational

- Understands world through logical thinking and categories
- think rigidly, has to follow a certain way

12 years + : Formal operational

- Understands world through hypothetical thinking and scientific reasoning
- realize that things can go a different way, not just rigid and one way

Moral Development - Kohlberg

- Pre-conventional level
- Conventional level
- Post-conventional, Autonomous, Principled Level

Pre-conventional level

- What we all start with
- What do we feel is moral, what is moral is what is good for me, i am the judge of morality

Conventional level

- Go along w/ what I feel is important
- Go along and agree with whatever group is important to us like family, school, ethnicity, etc.

Post-conventional, Autonomous, Principled Level

Do what is right no matter the personal cost

What is the single most important influence on physical growth?

Nutrition

What is the caloric requirement of infants?

110 - 120 cal / kg/ day (increased nutritional demand)
40 cal /kg/ day = adults

Physical Milestones

- Length: 50% increase by 1st year, born 20, see 30
- Weight: doubles by 6 months, triples by 1 year
- Lower incisors: erupt 1st 6-8 teeth by 1st birthday
- central lower incisors, sharp edge to cut and get nutrients
- anterior fontanels: close by 12-18 months, close early and brain can't fully grow, late = vulnerable. close bc walk and fall
- posterior fontanels: by 8 weeks

1-2 years alive

- gross and fine motor skills
- can think to have a goal in life
- understand world has center of gravity, cause and effect and can fall over
- build a tower of 4 blocks
- 2-3 word sentences to create a better meaning
- run, walk up stairs, going up is easier

2-3 years alive

- draw a circle - go through stages to get to completion
- jump, throw - define gravity is why like to jump

PLay and 15 month birth chart

on bookmarked slides

behavior guidelines

also look at toilet training

Nutrition

- nutrition: physical development depends on nutrition, need nutrition to meet different demands of life
- review feeding schedules, introduce solids, picky etaers
- when, what, how much need to eat

What is SIDS?

Kids prone tend to rebreathe their own CO2 and not able to roll over yet. So brain sense moving into respiratory acidosis but brain doesn't tell you to roll over

Prevention recommendations

- Guidance is minimal to 4 months (?)
- Back to sleep for every sleep
- Use a firm sleep surface: no sinking
- Practice room-sharing without bed-sharing
- Keep soft objects and loose bedding (use a fitted sheet) out of the crib (loose can crumple and form barrier -> rebreathe CO2)
- Avoid overheating, associated with increased incidence of SIDS
- Pacifier: has some protective value for SIDS

Immunizations

- Lower rates of compliance bc of economics, access, working parents, education about importance, misinformation about immunizations, religious beliefs, internet
- Update child's status at every opportunity; immunization status
- OK to give w/ minor illnesses, only held for bigger things
- Use schedule and check routes
- Need consent

Law in CA about immunizations

- All kids in schools or day cares must be vaccinated regardless of parents' religious and other personal beliefs. Kids with specific medical conditions, such as immune system deficiencies may be exempt if they have a doctor's note
- Opt out will have to be home schooled or enroll in an independent study program off school grounds
- Also not allow at public parks

Immunizations required to enter Kindergarten

- Polio
- Diphtheria, Tetanus, and Pertussis (DTaP)
- Measles, Mumps, and Rubella (MMR)
- Hepatitis B
- Varicella (Chickenpox)

IM Injections to kids

-

Notes on immunizations

- Parents may no longer opt out
- Must get consent each time
- Common illness not a contraindications; major ones yes bc immune system gets overwhelmed
- After shots expect: irritability, fever, red, sore at site. May give acetaminophen, ice pack for initial pain, warm cloth ok later; ice for cold analgesic, heat for vasodilation to move vaccine out of muscle

Rashes

- Rash is skin's message: not all rashes are equal, don't start or look the same

What questions do you ask about a rash?

- Immunization status: some childhood diseases have specific rash that goes with them (ex. have they had chicken pox or got the vaccine)
- Recent exposures: to other sick people, do you know what they had
- Prodrome: what was occurring before the rash erupted, some diseases have prodrome ex. restlessness, fever, no appetite,
- When and where did it start: in what order, each disease has own classical pattern
- Pruritic or painful: itchy or not, or painful
- Treatments used: home remedies, put in bath with oatmeal, butter, fire and ashes on rash - did it help, be respectful of what they did

Varicella Zoster

- No or mild prodrone
- Superficial vesicles: raised areas filled with serous fluid
- Extremely pruritic: itchy, most irritating part of disease
- Appear in crops in different stages: vesicles filled with serous fluid, break, dry on skin, crust over, new crop comes and repeat
- Can last 4-5 days, does not end until all the crops stop
- Concentrated on trunk, fewest on extremities
- Respiratory disease
- Exposed 14-21 days before eruption; rash has been happening for a few weeks before rash erupts
- Vaccine 85% effective
- Airborne isolation (negative pressure room): room has a little less pressure in room so air will not come out but hospital hallway air comes in
- Not dangerous disease but can be lethal to some immunocompromised kids

How to treat Varicella

- Child is contagious the day before the rash erupts and several days until everything has crusted over and no more crops
- Supportive treatment: no antivirals, fever control if necessary, address prutititus (benadryl, attarcats?), cool compress to mitigate itchy, sit in tepid bath with oatmeal = aveeno helps with itchy
- SDR of oral diphenhydramine: 1mg/kg
- Supplied as tablet bc most kids cant swallow pill

Shingles

- Immunization can prevent you from getting shingles.
- Virus lives in you once you get it but is dormant, after person is 60 there is waning of immune system -> shingles = neuropathy and is very painful
- Shingles vaccine can boost the immune system to keep shingles away

What is rubeola (measles)?

Respiratory disease from nasal airway can go into eyes -> conjunctvitis

Signs and symptoms of rubeola (measles)?

- 3-5 days prodrone: few days of fever and then got the rash
- 3 C's: coryza (painful inflammation of the nasal airway, nasal drainage blow and explode with touch nasal area from pain), cough, conjunctivitis
- KOPLIK spots: on buccal mucosa near molars (raised white areas on mucosa with blue dot in the middle)
- photophobia
- Confluent maculopapular rash: flows from HTT
- Can get a fine desquamation: rash and then flare or fall off

What are the 2 big risks/complications of measles?

Pneumonia: very severe viral pneumonia
Encephalitis: inflammation of the brain; seen as photophobia, hurts to look at light, pressure in head compresses optic nerves throughout brain; more severe than penumonia

Rubella (German Measles)

- No prodrome
- Discrete pinhead sized, macular rash begins on face and progresses to trunk and extremities
- Malaise, fever, headache (mild headache)
- Postauricular, suboccipital nodes (in axilla)
- lasts 2-3 days, then done, one of the most tolerated by kids
- Teratogenic: if child has this infects mother can cause blindness, deafness, and structural anomalies of heart, pregnant person needs immunization

Exanthem Subitum (Roseola)

- Herpesvirus type 6
- Sudden high fever (up to 105)
- Pink discrete maculopapular rash
- Risk of febrile seizures: seizure caused by high temperature
- Red is there bc causes a really high fever, pyrogens tell to turn thermostat way up -> red color of skin = body shunting blood up to surface to allow air to cool it off

Erythema Infectiosum (5th Disease)

- Human parvovirus B19, slap cheek disease, cheeks get very red
- Classic slapped cheek appearance that disappears within 1-4 days
- Body rash followed by lace-like pattern of erythema persists for weeks (lacy rash)
- Blood tests that look for antibodies against parovirus B19 used for exposed pregnant women: well tolerated by women but dangerous for exposed pregnant woman. Testing antibodies related to this.

Macule

Less than a cm across and is flat. Area of coloration that is brownish, orange color, like a freckle. A lot of diseases start with macule

Papule

Less than 1 cm. Is same color as macule but is raised. Can feel if run finger across skin, is orangey red

Vesicle

Less than 1cm, raised, filled with serous fluid/clear, 99% viral

Pustule

Less than 1cm, raised up, filled with pus = from bacteria

Bulla

Vesicle bigger than 1cm

Ulcer

Tissue that is lost, indentation, rather than being raised, get a lot from excoriation