Combo Peds Rotation

Diaper Dermatitis

Tx: Barrier ointment containing zinc or Vit A/D

Drug Eruptions

Exanthematous/Mobiliform Rash

Serum Sickness: Hypersensitivity Type 3

Tx: Antihistamines

Lichen Planus 5 P's

Purple, Polygonal, Planar, Pruritic, Papules

Wickham striae

Lacy striation on Lichen Planus lesion

Lichen Planus Tx

Tx: Topical Steroid Ointment, Antihistamines, PUVA

Poxvirus

Self-limiting

Discrete, dome-shaped, skin-colored papules w/ central umbilication

Molluscum Contagiosum

Tx: Cyrotherapy, curettage, cantharidin

*Test for other STI's (HIV)

Pityriasis Rosea

URI Sx's w/ a Herald Patch

Salmon-colored, raised rash w/ scales

Follows skin folds = Christmas tree-like pattern

Tx: Supportive, Diphenhydramine

Steven-Johnson Syndrome

Sulfa and Anticonvulsants

Sloughing <10% BSA

Fever, URI sx

Toxic Epidermal Necrolysis

Sulfa and Anticonvulsants

Sloughing >30% BSA

Fever, URI sx

Erythema Multiforme

Associated with HSV, Mycoplasma, Sulfa, B-Lactams, Phenytoin, Phenobarbital

Acne Vulgaris

Disease of piosebaceous follicles

Comedonal (Non-inflammatory acne)

Topical Retinoid

Mild papulopustular and mixed acne

Topical Retinoid

Benzoyl Peroxide + Topical Abx

Moderate papulopustular and mixed acne

Topical Retinoid

Oral Abx

Topical Benzoyl Peroxide

Severe Acne (Nodular)

Topical Retinoid

Oral Abx

Topical Benzoyl Peroxide

OR

Oral Isotretinoin

Pediculosis

LICE Intense itching

Tx: Permethrin

Scabies

Intense pruritic lesions, Linear burrows

Dx: Mineral Oil immersion

Tx: Permethrin

Oral Ivermectin if non responsive to initial Tx

Androgenetic Alopecia

Precoscious balding in children

Tx: Minoxidil, Finasteride

Roseola

HHV 6 - "The fever that rashes"

Fever > 104 x 4 days which resolves -->

Maculopapular rash on the trunk/neck -> face/extremities

Coxsackie Virus

Hand, Foot, Mouth Disease

Child <5 w/ fever, decreased appetite, papulovesicular rash

Herpangina- ulcers of the posterior oral cavity

Dx: clinical

When is a pt w/ Hand, Foot, and mouth dz no longer contagious?

When the skin lesions resolve

Mumps

Paramyxovirus

Painful parotid gland swelling in front and below the ear

Complication: Orchitis

Rubeola - English Measles Sx's

3 C's: Cough, Coryza, Conjunctivitis

Koplik spot - pinpoint gray lesions on oral mucosa

Red maculopapular rash: forehead -> trunk

High Fever

Tx: Supportive, Vitamin A

Rubella - German Measles Sx's

Low grade fever

Erythematous papular rash: face -> trunk

Posterior cervical lymphadenopathy

Tx: Supportive

Forchheimer Spots on palatine

Small neonate born w/ hepatosplenomegaly, jaundice, continuous machinery-like murmur, cataracts, sensorineural hearing loss, and thrombocytopenia

Blueberry muffin rash

Congenital Rubella (German Measles) during pregnancy - mother should have been screened/vaccinated

Erythema Infectiosum

Fifth's Disease - Parovirus B-19

"Slapped cheek" rash w/ perioral sparing

lacy-pink rash on torso

Fever, Arthropathy

Associated w/ hereditary spherocytosis & hydrops fetalis in pregnancy

First Degree Burn

Sunburn

Second Degree Burn

Painful

Partial Thickness

Blistering

Third Degree Burn

Full Thickness

Painless

Fourth Degree Burn

Black, Charred, Eschar

Painless

Burn Treatment

Cleansing= Water and mild soap

Chemical Burn= Irrigate 20 mintues

Antibiotics= Silver Sulfadiazine

IV Fluid= Parkland Formula

Urticaria

Blanchable, Edematous pink papules, wheals, or plaques

IgE mediated hypersensitivity Type I

Contact Dermatitis

T-Cell mediated hypersensitivity Type 4

Delayed Reaction

Atopic Dermatitis

Eczema

Infants: Cheeks

Kids: Flexor surfaces

Adults: Hands, Feet

Pruritus, irritated flexor creases, nummular coin shaped lesions

Atopic Dermatitis

Tx: Avoid trigger, antihistamines, emollients, topical steroids

Griseofulvin

Tinea Capitus - fungus on scalp, annular, scaling lesion

Oral dose

Take w/ high fat meal (peanut butter/ice cream)

Kerion

Raised, Boggy lesion w/ heaped, purulent nodules

Body's response to ringworm fungal infection

Painful, Hair loss, Fever, lymphadenopathy

Tx: Oral Griseofulvin

Dx of tinea

Wood's Lamp (blacklight)

KOH Prep

Tinea Barbae, Pedis, Cruris, Corporis

Beard, Foot, Jock Itch, Body

Tx: Topical Azoles > Oral Terbinifine or Itraconazole

Onychomycosis

Tx: Itraconazole + terbinafine

Impetigo

Staph or Strep

vesiculopustular honey colored crust

Tx: Mupirocin

Allergic Conjunctivitis & Rhinitis

Allergic Shiners

watery eyes & runny nose

cobblestone mucosa

Allergic Conjunctivitis & Rhinits Tx

Olopatadine (antihistamine)

Naphazoline (vasoconstrictor)

Neonatorum Conjunctivitis

2-4 days: N. gonnorheae - Tx w/ IV or IM Ceftriaxone

5-14 days: Chlamydia - Tx w/ PO Erythromycin

7-11 days: HSV

Bacterial Conjunctiviits

Staph/Strep Pink-Eye

Copious mucopurulent discharge

Eye crusting

Tx: Erythromycin

Bacterial Conjunctivitis Contact Lens

Pseudomonas

Tx: Fluoroquinolone (Cipro) or Aminoglycoside (Tobrex)

Orbital Cellulitis

7-12 y/o

Strep or H. influenzae B

Fever, proptosis, ↓ EOM, Swelling and redness

Dx: CT

Orbital Cellulitis TX

IV ABX= Vanco + Ceftriaxone/Unasyn/Zosyn

MSSA: Nafcillin or Oxicillin

If allergy to beta lactam or ceph = vanco + fluoroquinolone

Strabismus

Cross eye

Dx: Corneal Light Reflex, Cover test or Cover/Uncover

Tx: Prevent amblyopia

- Ophthalmology referral

Amblyopia

Birth - 8/9 y/o

Tx: Occlusion (Patch unaffected eye)

Dacrostenosis

Persistent tearing - incomplete lacrimal canal

Debris on eyelashes, erythema of lids, conjuctivitis

Px: Spontaneous resolution by 6 m/o

Tx: Message, Optho consult if not resolved by 1yr

Acute Otitis Media Dx

Bulging, erythematous TM

Acute Otitis Media TX

S. pneumoniae > H. influenzae > M. catarahlis

Amoxicillin

Referral to ENT for tympanostomy

3 OM infections in 6 mo

4 OM infection in 1 yr

OM infection non-responsive to 2 Abx regimen

20 or > dB hearing loss w/ persistent effusion

Allergic Rhinitis

Nasal polyps worse in AM

pale, violaceous, boggy turbinates, nasal polyps with cobblestone mucosa

SensoriNeural Loss

Weber= Normal Ear lateralization

Rinne= Normal Air > Bone

Conductive Loss

Weber= Lateralize to bad ear

Rinne= Bone > Air

Mastoidits

inflammation of the mastoid air cells of temporal bone

deep ear pain, mastoid tenderness

Recurrent or untreated AOM

Mastoiditis TX

ENT referral

IV Vanco

Tympanocentesis > Myringotomy > Mastoidectomy

Otitis Externa - Swimmer's Ear

Pseudomonas

ear pain, pruritius, auricular discharge

pain traction on tragus

Otitis Externa TX

Ciprofloxacin/ dexamethasone

Prevention: EtOH drops after swimming

Tympanic Membrane Perforation

Rapid pain release and otorrhea

Amoxicillin PO

Keep ear dry - F/U with pediatrician (monitor)

Epistaxis

Kaisselbach's Plexus - Anterior & Unilateral

Palantine a. - Posterior & Bilateral

Saddle-nose deformity from epistaxis

Septal Hematoma

Epistaxis TX

DIrect Pressure

Short acting topical decongestants

Cauterization of nasal packing

Fever

Anterior Lymphadenopathy

Cough is Absent

Exudates on tonsils

Strep Pharyngitis - GAS

5-15 y/o

Tx: Penicillin, Amoxicillin

Epiglottitis

2-7 y/o

H. influenzae

Respiratory distress, dysphagia, drooling

Tripod Position

Epiglottitis Dx & Tx

Cervical XR= Thumb print sign

Tx: Secure airway - NO looking or upsetting child

Augmetin or 2nd/3rd gen Cephalosporin

Oral Candidiasis

Whit curd like plaques

bleeds with scrape

Oral Candidiasis TX

Nystatin

Peritonsillar Abscess

muffled hot potato voice, trismus, uvula deviation to contralateral side

Peritonsillar Abscess DX

CT scan

Peritonsillar Abscess TX

ID and ABX= Unasyn or Clindamycin

Atrial Septal Defect

Opening between right and left atrium

Atrial Septal Defect Etiology

Ostium secundum

Atrial Septal Defect PE

systolic ejection

Crescendo-Decrescendo flow murmur at pulmonic area

Widely split Fixed S2

Atrial Septal Defect DX

CXR= Cardiomegaly

ECG= Incomplete RBB

Coarctation of Aorta

Congenital narrowing of descending thoracic aorta

Ductal-dependent cardiac lesion

Associated w/ Turner's Syndrome & Subarachnoid Hemorrhage

Coarctation of Aorta PE

BP is ↑ in upper extremity > lower

Skin color is pink: upper, blue: lower

Delayed or weak femoral pulses

Infraclavicular heart sounds

Coarctation of Aorta DX

CXR= 3 sign (rib notching)

Confirm: Angiogram

Coarctation of Aorta TX

Balloon angioplasty

PGE1 to keep PDA open

Patent Ductus Arteriosus

communication between descending thoracic aorta and pulmonary artery

Keep PDA open

PGE1 in Tetralogy of Fallot

Caution Apnea

Patent Ductus Arteriosus PE

Asymptomatic, poor feeding, wt loss, pulmonary congestion, Continuous machinery murmur

Patent Ductus Arteriosus closure

Symptomatic patent ductus arteriosus

Natural: Bradykinin production after 1st breath

Oxygen

NSAIDs; Indomethacin IV

Symptomatic: Ligation

Eisenmenger's Syndrome

Left to Right shunt becomes Right to Left shunt

Pressure in pulmonary vasculature builds

Late cyanosis

Incompatible w/ life

Tetralogy of Fallot

Cyanotic blue baby syndrome

Tet spells - hypercyanotic episodes

Harsh holosystolic murmur - LSB

Associated w/ DiGeorge Syndrome

PROVe Tetralogy of Fallot

Pulmonary Stenosis

Right Ventricular Hypertrophy

Overriding Aorta

VSD

extra-loud S2

Tetralogy of Fallot Dx & Tx

CXR= Boot Shaped

Tx: Knee to chest position, Keep PDA Open, Surgery at 3y/o

Ventricular Septal Defect

dyspnea with feeding, poor growth

Loud harsh holosystolic murmur heard at Lt lower sternal border

Ventricular Septal Defect DX

Echocardiogram

Rheumatic Fever

acute autoimmune inflammatory (IgG & IgM)

Anti-ASO titer

Molecular mimicry attacking the Mitral & Aortic vv.

Post GAS pharyngitis

Joints

Carditis

Neuro - chorea

Erythema marginosum

Subcutaneous nodules

Jones Criteria for Rheumatic Fever

Rheumatic Fever TX

Penicillin G

Aspirin

Kids < 7 y/o

3-6 weeks s/p strep throat

+ Strep skin infection: Impetigo

+ Hematuria w/ or w/o red cell casts

+ HTN

+ Edema

Post-Strep Glomerulonephritis

Acute Nephritis in children

Kawasaki Disease complication

Coronary Artery Spasm/Aneurism

(#1 cause of heart disease in kids)

CRASH and Burn for Kawasaki

Conjunctivitis - bilaterally

Rash - Non vesicular, non bullae

Adenopathy

Strawberry tongue

Hand/Foot edema & possible desquamation

Burn: High fever for 5 days

Kawasaki Disease TX

High-dose Aspirin, Immunoglobulin IV

Hypertrophic Cardiomyopathy

Ventricle Septum Hypertrophy

Diastolic dysfunction

Sudden cardiac death of a young athlete

Hypertrophic Cardiomyopathy DX

Adolescent c/o Syncope, Angina, Dyspnea

S4 Systolic Murmur

Broad, deep Q-waves on EKG

Echocardiogram