10/19/23, 1:44 PM 602 midterm study guide
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TOPICS Covered
oChalazions
oBlepharitis
oConjunctivitis
oHand-foot-mouth syndrome
oStrep pharyngitis
oKawasaki disease
oRheumatic fever
oMilia
oPort-wine stain/Nevus flammeus
oSalmon patch
oCafé-au lait spot
oImpetigo
oMolluscum Contagiosum
oVerruca Vulgaris
oHerpetic Whitlow
CHALAZIONS – Benign, chronic lipogranulomatous i nflammation of the eyelid
Causes – blockage of the meibomian cyst
Risk – hordeolum or any condition which may imped e flow through the meibomian gland. Also mite species that reside in lash follicles
Assessment – P AINLESS, NOT INVOL VING LASHES Lid edema, or palpable mass Red or grey mass on the inner aspect of lid margin
Prevention – good eye hygiene
Treatment – warm, moist compresses 3x per day Antibiotics not indic ated because chalazion is granulomatous condition, if seco ndarily infected consider SULF ACET AMIDE, ERYTHROMYCIN
Follow up – 2-4 weeks, if still present af ter 6 weeks follow up with ophthalmologist
BLEPHARITIS – Inflamation/infection of th e lid margins (chronic problem) 10/19/23, 1:44 PM 602 midterm study guide
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2 types – (non ulcerative) : irritants ( smoke, make up, chemicals) seborrheic s&s – chronic inflammati on of the eyelid, erythema, greasy scaling of anterior ey elid, loss of eyelashes, seborrhea dermatitis of ey ebrows and scalp Ulcerative- infection with staphylococcus or streptoc occus s&s – itching, tearing, recurrent sty es, chalazia, photophobia, small ulceration at ey elid margin, broken or absent eyelashes
●the most frequent complaint is ongoin g eye irritation and conjunctiva redness Treatment – clean with baby shampoo 2-4 times a day , warm compresses, lid massage (right after warm compress)
For infected eyelids – antistaphylocc ocal antibiotics BACITRACIN, ERYTHR OMYCIN 0.05% for 1 week AND QUIONOLONE OINTMENTS
For infection resistant to topical – TETRACYCLINE 250 MG PO X4 DOXYCYCLINE 100 MG PO X2
CONJUCTIVITIS – inflammation or irritation o f conjuctiva
Bacterial (PINK EYE) – in peds b acteria is the mosts common cause, contact lens, rubbing eyes, tra uma, S&S – purulent exudate, initially u nilateral, then bilateral
Sensation of having foreign bo dy in the eye is common
Key findings – redness, yellow gree n, puru,ent discharge, crust and matted eyelids in am
Self limiting 5-7 days. Eye drops – polytrim, erythromycin, tobramycin or cipro
Improvement 2-4 days
Most common organism H. influenza <7
Viral – adenovirus , coxsackie virus, herpes, molluscum S&S – pro fuse tearing, mucous discharge, burning, concurrent UR I, enlarged or tender preauricular nose
Antihistamines/decongestant
Improvement, self limiting, 7-14 days
Chlamydial – chlamydia trachomatis S& S – profuse exudate, associated with genitourinary symptoms, 1-2 weeks after birth Gonococcal – 2-4 days aft er birth, most concern can cause blidness
PO azithromycin, doxycycline (tetracyclines i ncrease photosensitivity , don’t use in pregnancy)
Improvement 2-3 weeks
Allergic – IgE mast cell reaction, envi ronmental, cosmetics S&S – marke d conjuctival edema, severe itching, tearing, sn eezing
Topical antihistamine or topical steroids
Improvement 2-3 days
Chemical – thimerosal, erythromycin, silver nitrate S&S conjuctival ery thema, 30 minutes afer prophylactic antibiotics dro ps
Avoid co ntact
Can consider steroids
Conjunctivitis never accompany vi sion changes 10/19/23, 1:44 PM 602 midterm study guide
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Diagnostic studies: swap and scraping must be don e, gram and Giemsa staining, ELISA, PCR testing, n ewborn < 2 weeks needs to be tested for g onorrhea
Non –pharm – clean towels, change pillows, warm compr ess, no contacts, no eye make up – mascara
Gonococcal conjunctivitis : newborn – give Ceftri aaxone IM once (don’t give if hyperbilirubinemia,
Non-gonococcal – erythromycin 0.5% ointment
Consider fluorescein staining if abrasi on suspected
CDC recommends prophylactic administration of a ntibiotic eye ointment (ER YTHROMYCIN) 1 hour after delivery
Refer to ophthalmologist if her pes, hemorrhagic conjunctivitis or ulcerations present
May return to work/school 24 hours af ter topical HAND-FOOT -AND-MOUTH DISEASE – HIGHL Y CONT AGIOUS, viral illness
clinical entity evidenced by fever , vesicular eruptions in the oropharynx that may ul cerate and a maculopapular rash involving hands and feet, the r ash evolves to vesicles, especially on the dorsa of the h ands and feet. Last 1 to 2 weeks.
lesions appear on the buccal mucosa , palate, palms of hands, soles of feet and but tocs
most common cause – COXSACKIE A 16
common in children <5
S&S – low grade fever , malaise, abdominal pain, enlarged anterior cervical n odes or submandibular
Oral – small red papules on the to ngue and buccal mucosa, which will progress to ulcerative vesicles
EXANTHEM (papulovesicular) – occurs 1-2 days aft er oral lesions
Differenti al – herpangina, Stevens- Johnson syndrome
Treatment – maintain hydration, cool liquids, avoid spicy food, rest
Topical aluminum hydroxide/ magnesium hy droxide gel with diphenhydramine applied to painful lesions
Topical anesthetics – Kank A, Orabase
Resolution with 7 days
STREP PHAR YNGITIS – An acute inflammatio n of pharynx/tonsils, associated with crowding (school) 10/19/23, 1:44 PM 602 midterm study guide
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rare in children <3
Viral – rhinovirus, adenovirus, parainfluenza, Epstein-barr virus
Bacterial- group A beta hemolytic streptococcus
Risk – family hx of rheumatic fever , day care
S&S – sore throat, tonsillar exi date, malaise
Strep: cervical adenopathy , fever >102F , no cough or nasal congestion, petechiae on sof t palate, “Beefy Red” tonsils, “sandpaper” rash (nose, neck and torso), abdominal pain, headache
Suggestive of viral : conjunctivitis, nas al congestion, cough, diarrhea When cough - almost always exclude Str eptococcus
Tests – rapid strep test CBC: W BC shift to left
Monospot if mono suspected
Treatment: gargling with salt water , change toothbrush, incubation perio d 2-5 days
PCN – one IM or 10 days treatm ent PO
First generation cephalosporins – 10 days tr eatment
Azithromycin (if PCN allergy)
Consult/referral – evidence of acut e renal failure and reddish, tea collared urine (2-3 weeks post infection)
No longer contagious after 24 ho urs on antibiotics, peak fever on days 2and 3, las t 4-10 days
KAWASAKI DISEASE (also known as mucocutaneous lymph nodesyndrome or i nfantile polyarteritis – an acute, febrile, immune-medicated, self-limited dis ease characterized by vasculitis. Leading caus e of acquired heart disease in children
