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NR602 Midterm Exam 2022

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What is a chalazion? - ANSWER Benign, chronic lipogranulomatous inflammation of the eyelid What causes a chalazion? - ANSWER Blockage of the meibomian gland What puts a person at risk for a chal... azion? - ANSWER 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? - ANSWER 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? - ANSWER Good eye hygiene What is treatment for chalazion? - ANSWER Warm, moist compresses 3x a day If secondarily infected: sulfacetamide or erythromycin What is the follow-up for chalazion? - ANSWER In 2-4 weeks If still present after 6wks, follow up w/ophthalmologist What is blepharitis? - ANSWER Inflammation/infection of the lid margins (chronic problem) What are the two types of blepharitis? - ANSWER Seborrheic (non-ulcerative) Ulcerative What can cause seborrheic blepharitis? - ANSWER Irritants (smoke, makeup, chemicals) What are s/s of seborrheic blepharitis? - ANSWER Chronic inflammation of eyelid Erythema Greasy scaling of anterior eyelid Loss of eyelashes Seborrheic dermatitis of eyebrows/scalp What usually causes ulcerative blepharitis? - ANSWER Infection w/staph or strep What are s/s of ulcerative blepharitis? - ANSWER 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? - ANSWER Clean w/baby shampoo 2-4 times/day Warm compresses Lid massage (right after warm massage) How are infected eyelids with blepharitis treated? - ANSWER Antistaph abx: bacitracin, erythromycin 0.05% x1 wk and quinolone ointments How is blepharitis infection resistant to topical abx treated? - ANSWER Tetracycline 250mg PO x4 Doxy 100mg PO x2 What is conjunctivitis? - ANSWER Inflammation or irritation of conjunctiva What is the most common cause of conjunctivitis in peds? - ANSWER Bacteria What are some common causes of bacterial conjunctivitis? - ANSWER Contact lenses Rubbing eyes Trauma What are s/s of bacterial conjunctivitis? - ANSWER 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? - ANSWER 5-7 days (self-limiting) What is the treatment for bacterial conjunctivitis? - ANSWER Eye drops: polytrim, erythromycin, tobramycin, cipro What is the most common organism causing bacterial conjunctivitis? - ANSWER H. influenza What are common causative organisms of viral conjunctivitis? - ANSWER Adenovirus Coxsackie Herpes Molluscum What are s/s of viral conjunctivitis? - ANSWER Profuse tearing Mucus drainage Burning Concurrent URI Enlarged/tender preauricular nodes What is treatment for viral conjunctivitis? - ANSWER Antihistamine Decongestant How long does viral conjunctivitis usually last? - ANSWER 7-14 days (self-limiting) What is the cause of chlamydial conjunctivitis? - ANSWER Chlamydial trachomatis What are s/s of chlamydial conjunctivitis? - ANSWER Profuse exudate Associated w/GU s/s 1-2wks after birth When does gonococcal conjunctivitis usually occur? - ANSWER 2-4d after birth What is the biggest concern with gonococcal conjunctivitis? - ANSWER Can cause blindness What is the treatment for chlamydial conjunctivitis? - ANSWER PO azithromycin, doxy (tetracyclines increase photosensitivity, don't use in pregnancy) When does chlamydial conjunctivitis usually improve? - ANSWER 2-3wks What causes allergic conjunctivitis? - ANSWER IgE mast cell reaction Environmental Cosmetics What are s/s of allergic conjunctivitis? - ANSWER Marked conjunctival edema Severe itching Tearing Sneezing How is allergic conjunctivitis treated? - ANSWER Topical antihistamine or topical steroids When is improvement usually seen in allergic conjunctivitis? - ANSWER 2-3 days How is chemical conjunctivitis treated? - ANSWER Thimerosal Erythromycin Silver nitrate What are s/s of chemical conjunctivitis? - ANSWER Conjunctival erythema Conjunctivitis never accompanies _______________ ________________. - ANSWER Vision changes When is ophthalmology referral necessary for conjunctivitis? - ANSWER Herpes Hemorrhagic Ulcerations When can a pt return to work/school with conjunctivitis? - ANSWER 24h after topical abx What is hand foot mouth? - ANSWER Highly contagious viral illness, most common in kids <5 What is the most common cause of HFM? - ANSWER Coxsackie A 16 What are s/s of HFM? - ANSWER 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? - ANSWER 1-2wks When does the exanthem of HFM occur? - ANSWER Usually 1-2 days after oral lesions What are some differentials for HFM? - ANSWER Herpangina Stevens-Johnson syndrome What is the treatment for HFM? - ANSWER 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? - ANSWER Acute inflammation of pharynx/tonsils, associated w/crowding (like school, daycare) What are s/s of viral pharyngitis? - ANSWER Red/swollen tonsils Red/swollen throat Cough (almost always excludes Strep) Conjunctivitis Nasal congestion Diarrhea What are s/s of bacterial pharyngitis? - ANSWER Swollen uvula White spots Red/swollen tonsils Red/swollen throat Gray, furry tongue What commonly causes viral pharyngitis? - ANSWER Rhinovirus Adenovirus Parainfluenza Epstein-barr virus What commonly causes bacterial pharyngitis? - ANSWER Group A strep What increases the risk of getting pharyngitis? - ANSWER Fam h/o rheumatic fever Day care What are s/s of strep throat? - ANSWER 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? - ANSWER Rapid strep CBC (WBC shift to the left) Monospot if mono suspected What are some treatments for pharyngitis? - ANSWER 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? - ANSWER 2-5d When is a consult/referral needed for pharyngitis? - ANSWER Evidence of acute renal failure Reddish, tea colored urine (2-3w post-infection) When is a pt no longer contagious with pharyngitis? - ANSWER After 24h on abx What is kawasaki dz? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER IVIG single dose 2g/kg over 12h in first 10d ASA 80-100mg/kg/d in 4 doses What are some complications of Kawasaki? - ANSWER MI Development/rupture of coronary artery aneurysm (may cause emboli, HF, heart valve probs, dysrhythmia, myocarditis) What is rheumatic fever? - ANSWER Inflammatory dz that develops in 1-3% of kids who have untreated group A strep. What all can rheumatic fever affect? - ANSWER Heart Blood vessels Joints Skin CNS Connective tissues What are s/s of rheumatic fever? - ANSWER 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? - ANSWER Throat cultures Negative antigen test ESR CRP ASO titers EKG CXR CBC What is treatment for rheumatic fever? - ANSWER First line: PCN If allergic to PCN: azithro Prednisone ASA No prophylaxis for endocarditis in rheumatic fever What is milia? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER Smooth, regular borders of darkened patch If a child has >5 cafe au lait spots that are >1.5cm, what should be suspected? - ANSWER 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? - ANSWER Neurofibromatosis What is a rare but diagnostic sign of neurofibromatosis? - ANSWER Smaller 1-4cm diameter cafe au lait spots in axillae (axillary freckling or Crow's sign) What is a hemangioma? - ANSWER 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? - ANSWER Bright red vascular overgrowth Elevated Vary in size What is a possible treatment for strawberry hemangioma? - ANSWER Steroids What is impetigo? - ANSWER Superficial infection of skin that begins as small superficial vesicles that rupture/form honey colored crust Usually 2-5yo What causes bullous impetigo? - ANSWER Staph aureus or group A strep What causes non-bullous impetigo? - ANSWER MRSA What does non-bullous impetigo look like? - ANSWER 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? - ANSWER 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? - ANSWER 7-10d What is molluscum contagiosum? - ANSWER 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? - ANSWER Usually 6-12mo, but can take as long as 4yrs What do molluscum lesions looks like? - ANSWER 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? - ANSWER Rarely on palms/soles How is molluscum spread? - ANSWER Direct person-to-person physical contact and through contaminated fomites What are fomites? - ANSWER Inanimate objects that can become contaminated w/virus What is the treatment for molluscum? - ANSWER 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? - ANSWER Wart: painless, benign skin tumor, viral (HPV 6 or ll) What are the characteristics of the common wart? - ANSWER Rough surface Elevated Flesh-colored What is the treatment for warts? - ANSWER 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? - ANSWER When it is resistant to therapy. What is herpetic whitlow? - ANSWER Swollen, painful lesion w/erythematous base/ulceration resembling paronychia Where does herpetic whitlow usually occur? - ANSWER Finger or thumb of thumb-sucking kids w/gingivostomatitis or adolescents w/genital HSV infection How long are herpetic whitlow lesions contagious? - ANSWER As long as they are present Incubation period 2-12d What are s/s of herpetic whitlow? - ANSWER Primary herpes Fever Malaise Sore throat Decrease fluid intake Deep-appearing vesicles on fingers What are some diagnostic studies for herpetic whitlow? - ANSWER 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? - ANSWE [Show More]

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