What is a chalazion? - ANSWER Benign, chronic lipogranulomatous inflammation of the eyelid
What causes a chalazion? - ANSWER Blockage of the meibomian
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What puts a person at risk for a chalazion? - 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 Less]