symptoms 2x or less per week Step 2 Asthma Approach-Mild persistent<\/a><\/p>\n\n\n\n Symptoms >2 x a week, less than once per day Step 3 Asthma Approach-Moderate Persistant<\/a><\/p>\n\n\n\n daily symptoms Step 4 Asthma Approach-Severe Persistent<\/a><\/p>\n\n\n\n continual symptoms Tx of asthma<\/a><\/p>\n\n\n\n Stepwise approach Step 6 Asthma Approach<\/a><\/p>\n\n\n\n Bulbar\/palpebral conjunctival infection<\/a><\/p>\n\n\n\n May be unilateral or bilateral<\/a><\/p>\n\n\n\n Leukocoria<\/a><\/p>\n\n\n\n abnormal appearance of a white film in the pupil; immediate referral to pediatric ophthalmologist warranted Visual screening in children<\/a><\/p>\n\n\n\n At least once between ages 3-5 y\/o according to USPSTF<\/a><\/p>\n\n\n\n AOM<\/a><\/p>\n\n\n\n RF: genetics, males, Native American, siblings, low economic status, ages 6mo-3y, winter, supine bottle feeding, daycare, tobacco smoke<\/a><\/p>\n\n\n\n S\/S of AOM<\/a><\/p>\n\n\n\n erythema, otalgia, bulging TM, absent cone of light<\/a><\/p>\n\n\n\n Dx of AOM<\/a><\/p>\n\n\n\n Audiometry, tympanometry, possible lateral neck xray to r\/o mass<\/a><\/p>\n\n\n\n TX of AOM<\/a><\/p>\n\n\n\n uncomplicated: supportive with tylenol\/ibuprofen; watchful waiting 48-72 in 6m-2y\/o; <5 benzocaine otic drops Bacterial rhinosinusitis<\/a><\/p>\n\n\n\n Preceded by URI-typically worsens after 5-7 days- not resolved in 2 weeks<\/a><\/p>\n\n\n\n Sx of bacterial rhinosinusitis<\/a><\/p>\n\n\n\n Purulant nasal congestion, drainage, facial pain, headache, fever Bronchiolitis<\/a><\/p>\n\n\n\n Usually caused by RSV S\/s of bronchiolitis<\/a><\/p>\n\n\n\n Increased work of breathing, prolonged expiration, grunting, retractions, nasal flaring<\/a><\/p>\n\n\n\n Croup sx<\/a><\/p>\n\n\n\n Low grade fever, URI symptoms, barking cough, inspiratory stridor can occur<\/a><\/p>\n\n\n\n Croup dx<\/a><\/p>\n\n\n\n Made from symptoms<\/a><\/p>\n\n\n\n Croup tx<\/a><\/p>\n\n\n\n Glucocorticoids possibly Lead poisoning<\/a><\/p>\n\n\n\n Inactivated heme synthesis by inhibiting insertion of iron-leads to microcytic hypochromic anemia<\/a><\/p>\n\n\n\n Source of lead poisoning<\/a><\/p>\n\n\n\n Lead based pain<\/a><\/p>\n\n\n\n Those at risk for lead poisoning<\/a><\/p>\n\n\n\n Children 2-3 y\/o Lead poisoning testing<\/a><\/p>\n\n\n\n Children with Medicaid need lead level @ 12 months and 24 months-capillary finger stick with venous sample as f\/u Lead levels<\/a><\/p>\n\n\n\n <5 is normal Genu varum<\/a><\/p>\n\n\n\n Bow legged as a result of uterine position- normal finding up to 3y\/o<\/a><\/p>\n\n\n\n Legg-Calve-Perthes Disease<\/a><\/p>\n\n\n\n Avascular necrosis of femoral head- epiphyses associated with trauma, synovitis<\/a><\/p>\n\n\n\n Legg-Calve-Perthes Disease RF<\/a><\/p>\n\n\n\n Associated with low birth weight, socioeconomic status, or white race<\/a><\/p>\n\n\n\n Legg-Calve-Perthes Disease s\/s<\/a><\/p>\n\n\n\n Onset of painful limp of thigh, knee, or hip worse with activity, not relieved by rest Legg-Calve-Perthes Disease Tx<\/a><\/p>\n\n\n\n Abduction brace or long leg cast<\/a><\/p>\n\n\n\n Congenital Hip Dysplasia s\/s<\/a><\/p>\n\n\n\n Thick fold asymmetry, leg length inequality, walking children- painless limp<\/a><\/p>\n\n\n\n Congenital Hip Dysplasia Dx & Tx<\/a><\/p>\n\n\n\n Positive Barlow maneuver, ortolani or Allis sign Toxic trait synovitis<\/a><\/p>\n\n\n\n Unilateral inflammation arthritis; acute onset; decreased ROM extension and internal rotation; painful hip, crying at night; common in boy 3-6 y\/o<\/a><\/p>\n\n\n\n Toxic trait synovitis Dx and Tx<\/a><\/p>\n\n\n\n Dx: WBC with leukocytosis, increased ESR, hip xray normal Impetigo<\/a><\/p>\n\n\n\n Superficial layers of the skin Impetigo exam<\/a><\/p>\n\n\n\n Lesions on hand, face, neck, extremities or perineium; regional lymphadenopathy<\/a><\/p>\n\n\n\n Impetigo treatment<\/a><\/p>\n\n\n\n Topical antx if superficial, nonbullous or localized to one area Cellulitis<\/a><\/p>\n\n\n\n In children often periorbital, perivaginal, perinatal, or buccal<\/a><\/p>\n\n\n\n Cellulitis hx<\/a><\/p>\n\n\n\n Recent URI, fever, pain, malaise<\/a><\/p>\n\n\n\n Cellulitis exam<\/a><\/p>\n\n\n\n Buccal cellulitis-blue\/purple tinged= h.influenzae<\/a><\/p>\n\n\n\n Cellulitis Dx<\/a><\/p>\n\n\n\n CBC, BCx if child appears toxic, has fever, or is <1<\/a><\/p>\n\n\n\n Cellulitis tx<\/a><\/p>\n\n\n\n IV antx Folliculitis<\/a><\/p>\n\n\n\n Infection of hair follicle; s. Aerous most common<\/a><\/p>\n\n\n\n furnucle<\/a><\/p>\n\n\n\n Deeper infection of hair follicle involving the deep dermis<\/a><\/p>\n\n\n\n Hot tub folliculitis<\/a><\/p>\n\n\n\n Pseudomonas aeruginosa<\/a><\/p>\n\n\n\n Dx of folliculitis & furnucle<\/a><\/p>\n\n\n\n Grain stain and cx<\/a><\/p>\n\n\n\n Management of folliculitis and furnucle<\/a><\/p>\n\n\n\n Warm compresses, benzoyl peroxide Paronychia<\/a><\/p>\n\n\n\n Infection around fingernail\/toenail Paronychia tx<\/a><\/p>\n\n\n\n Systemic oral antx if acute infection present Candiasis<\/a><\/p>\n\n\n\n Tx: thrush-oral nystatin QID Tinea captitis<\/a><\/p>\n\n\n\n ringworm of the scalp tx of tinea capitis<\/a><\/p>\n\n\n\n griseofulvin ultramicrosize once or twice daily for 6-8 weeks, take with fatty food to increase absorption tinea corporis<\/a><\/p>\n\n\n\n ringworm tx for tinea corporis<\/a><\/p>\n\n\n\n topical antifungals miconazole or clotrimazole 1-4 weeks BID<\/a><\/p>\n\n\n\n Tinea cruris<\/a><\/p>\n\n\n\n jock itch tinea pedis<\/a><\/p>\n\n\n\n 3-6 weeks of antifungals<\/a><\/p>\n\n\n\n onychomycosis<\/a><\/p>\n\n\n\n fungal infection of the nail tinea versicolor<\/a><\/p>\n\n\n\n a fungal infection that causes painless, discolored areas on the skin herpex simplex<\/a><\/p>\n\n\n\n HSV type 1-oral mucosa, pharynx, lips Herpes simplex exam<\/a><\/p>\n\n\n\n HSV-1= gingivostomatitis- grouped vesicle that ulcerate and form white plaques on mucosa, gingiva, tongue, chin, labial folds Herpes simplex dx & tx<\/a><\/p>\n\n\n\n Dx: viral cx= gold standard for diagnosis Herpes zoster<\/a><\/p>\n\n\n\n shingles
asymptomatic and normal PED
requires SABA 2 days\/week
no interference with normal activities
brief exacerbations
nighttime symptoms 2x or less a month
lung fx- FEV>80% predicted<\/a><\/p>\n\n\n\n
requires SABA more than 2days\/week, no more than once a day
exacerbations may affect activity
nighttime symptoms 3-4x a month
FEV> 80% predicted<\/a><\/p>\n\n\n\n
daily use of SABA
some limitations
2x or more per week exacerbations
nighttime symptoms more than 1x per week, not nightly
FEV >60% but <80%<\/a><\/p>\n\n\n\n
requires SABA multiple x a day
extremely limited activity
nighttime symptoms 7x a week
FEV <60%<\/a><\/p>\n\n\n\n
step 1: SABA PRN
step 2: low dose ICS
Step 3: low dose ICS+ LABA or medium dose ICS
step 4: Medium dose ICS+LABA
Step 5: high dose ICS+ LABA
Step 6: High dose ICS+LABA + corticosteroid<\/a><\/p>\n\n\n\n
Causes: retinal detachment, cataract, retinal dysplasia, newborn retinoblastoma<\/a><\/p>\n\n\n\n
1st line antx: amoxicillin 80-90mg\/kg\/day Q12 x 10days
if allergy to PCN- augmentin, cefuroxime<\/a><\/p>\n\n\n\n
No imaging required- if no improvement refer to ENT<\/a><\/p>\n\n\n\n
wheezing present
<2 y\/o
other causes; influenza, adenovirus, rhinovirus<\/a><\/p>\n\n\n\n
0.6mg\/kg-1mg\/kg
humidified air
bronchodilators<\/a><\/p>\n\n\n\n
summer months<\/a><\/p>\n\n\n\n
AAP recommends 6-9-12-18-24 mo as well as 3-4-5-6 y\/o<\/a><\/p>\n\n\n\n
>69 requires chelation<\/a><\/p>\n\n\n\n
restricted by abduction and rotation of affected hip<\/a><\/p>\n\n\n\n
US for <4 months, X-ray AP of pelvis >4 months
Tx: refer to orthopedist, pavlik harness, child should be seen weekly to prevent skin breakdown, necrosis<\/a><\/p>\n\n\n\n
To: BR, NSAIDs, non WB<\/a><\/p>\n\n\n\n
Nonbullous or bullous
nonbullous= honey-colored crusts on lesions
caused by group A streptococcus, S.aerous or MRSA
occurs more in summer months, low socioeconomic class<\/a><\/p>\n\n\n\n
bacitracin
neomycin
polymyxin B
Widespread infection again S. Aerous= Augmentin, cephelexin, dicloxacillin, cloxacillin for 7-10 days<\/a><\/p>\n\n\n\n
if streptococcal= PCN, if allergy 3rd generation cephalosporin
if staphylococcus=bactrim if child >2 months; doxy if child >8 and < 45 kg
MRSA suspected= clindamycin
H.influenzae=augmentin x 10 days<\/a><\/p>\n\n\n\n
if superficial- topical antx-erythromycin or clindamycin
if severe or widespread- cephalexin or dicloxacillin<\/a><\/p>\n\n\n\n
S.aerous #1 then streptococcus or pseudomonas<\/a><\/p>\n\n\n\n
candida-nystatin
if purulant-loosen cuticle with blade<\/a><\/p>\n\n\n\n
if resistant to tx: oral fluconazole
skin diaper rash-nystatin, ketonazole<\/a><\/p>\n\n\n\n
diffuse fine scale without obvious hair loss
discrete area of hair loss with broken hairs (black dot ringworm)
trichophyton tonsurans and microsporum canis-most common organisms
African American boys most common<\/a><\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/lLzJTg.LV9OjNtCdOLQZNA.jpg\")
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shampoo with econazole or ketonazole in addition<\/a><\/p>\n\n\n\n
found on non hairy part of body<\/a><\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/V-76RDyeXSpBSRIu1W3jdQ.jpg\")
<\/figure>\n\n\n\n
4-6week of antifungals<\/a><\/p>\n\n\n\n
typically with T.rubrum or candida
exam= opaque, white, silvery nail that becomes thick\/yellow
seldom symmetrical
tx: oral terbinafine, fluconazole, itraconazole<\/a><\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/gNfEaNmFLUniyU9EEBnJog.jpg\")
<\/figure>\n\n\n\n
occurs on the trunk
more in adolescents, warm weather, immunocompromised
exam= hypopigmented or hyper (salmon colored to brown) with raindrop or guttate appearance
Tx: selenium sulfide lotion or shampoo for 2-4 weeks
older adolescents can use ketonazole<\/a><\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/F9fza09Y0C2ZP1pQB8ZXTQ.jpg\")
<\/figure>\n\n\n\n
caused by herpes labialis-cold sore\/fever blister
HSV-2 neonatal<\/a><\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/JcBc4O8VEIUBjrbAIGKqPA.png\")
<\/figure>\n\n\n\n
halitosis present
herpes labialis-cluster of small clear vesicle with erythematous base usually only on one side of the mouth
HSV-2= grouped vesicopustules and ulceration with edema, primary lesions on vaginal mucosa, labia, perineum, penile shaft<\/p>\n\n\n\n
Tx: acyclovir 20-40mg\/kg\/dose 5x daily for 5 days<\/a><\/p>\n\n\n\n
more common in adolescents
exam- 2-3 clustered groups of macules and papules-progress to vesicle on the a red based, vesicles become pustular, rupture, and crust
Tx: antivirals not usually recommended unless immunocompromised.<\/a><\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/hR05tCKQzeyWhYTLyvH9qA.jpg\")
<\/figure>\n\n\n\n