NR 602 midterm study guide graded A
MIDTERM STUDY GUIDE: PART-1
TOPICS Covered
o Chalazions
o Blepharitis
o Conjunctivitis
o Hand-foot-mouth syndrome
o Strep pharyngitis
o Kawasaki disease
o Rheumatic fever
o Milia
o Port-wine stain/Nevus flammeus
o Salmon patch
o Café-au lait spot
o Impetigo
o Molluscum Contagiosum
o Verruca Vulgaris
o Herpetic Whitlow
o Hemanginoma
o Otitis media
o Otitis Externa
CHALAZIONS – Benign, chronic lipogranulomatous inflammation of the eyelid
Causes – blockage of the meibomian cyst
Risk – hordeolum or any condition which may impede flow through the meibomian gland. Also mite species that
reside in lash follicles
Assessment – PAINLESS, NOT INVOLVING 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 indicated because chalazion is granulomatous condition, if secondarily infected
consider SULFACETAMIDE, ERYTHROMYCIN
Follow up – 2-4 weeks, if still present after 6 weeks follow up with ophthalmologist
,NR 602 midterm study guide graded A
BLEPHARITIS – Inflamation/infection of the lid margins (chronic problem)
2 types – seborrheic (non ulcerative) : irritants (smoke, make up, chemicals)
s&s – chronic inflammation of the eyelid, erythema, greasy scaling of anterior eyelid, loss of
eyelashes, seborrhea dermatitis of eyebrows and scalp
Ulcerative- infection with staphylococcus or streptococcus
s&s – itching, tearing, recurrent styes, chalazia, photophobia, small ulceration at
eyelid margin, broken or absent eyelashes
● the most frequent complaint is ongoing 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 – antistaphyloccocal antibiotics BACITRACIN, ERYTHROMYCIN 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 of conjuctiva
Bacterial (PINK EYE) – in peds bacteria is the mosts common cause, contact lens, rubbing eyes, trauma,
S&S – purulent exudate, initially unilateral, then bilateral
Sensation of having foreign body in the eye is common
Key findings – redness, yellow green, 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 – profuse tearing, mucous discharge, burning, concurrent URI, enlarged or tender preauricular nose
Antihistamines/decongestant
Improvement, self limiting, 7-14 days
,NR 602 midterm study guide graded A
Chlamydial – chlamydia trachomatis
S&S – profuse exudate, associated with genitourinary symptoms, 1-2 weeks after birth
Gonococcal – 2-4 days after birth, most concern can cause blidness
PO azithromycin, doxycycline (tetracyclines increase photosensitivity, don’t use in pregnancy)
Improvement 2-3 weeks
Allergic – IgE mast cell reaction, environmental, cosmetics
S&S – marked conjuctival edema, severe itching, tearing, sneezing
Topical antihistamine or topical steroids
Improvement 2-3 days
Chemical –thimerosal, erythromycin, silver nitrate
S&S conjuctival erythema, 30 minutes afer prophylactic antibiotics drops
Avoid contact
Can consider steroids
Conjunctivitis never accompany vision changes
Diagnostic studies: swap and scraping must be done, gram and Giemsa staining, ELISA, PCR testing, newborn < 2
weeks needs to be tested for gonorrhea
Non –pharm – clean towels, change pillows, warm compress, no contacts, no eye make up – mascara
Gonococcal conjunctivitis: newborn – give Ceftriaaxone IM once (don’t give if hyperbilirubinemia,
Non-gonococcal – erythromycin 0.5% ointment
Consider fluorescein staining if abrasion suspected
CDC recommends prophylactic administration of antibiotic eye ointment (ERYTHROMYCIN) 1 hour after delivery
Refer to ophthalmologist if herpes, hemorrhagic conjunctivitis or ulcerations present
May return to work/school 24 hours after topical
HAND-FOOT-AND-MOUTH DISEASE – HIGHLY CONTAGIOUS, viral illness
clinical entity evidenced by fever, vesicular eruptions in the oropharynx that may ulcerate and a maculopapular rash
involving hands and feet, the rash evolves to vesicles, especially on the dorsa of the hands and feet. Last 1 to 2
weeks.
lesions appear on the buccal mucosa, palate, palms of hands, soles of feet and buttocs
, NR 602 midterm study guide graded A
most common cause – COXSACKIE A
16 common in children <5
S&S – low grade fever, malaise, abdominal pain, enlarged anterior cervical nodes or submandibular
Oral – small red papules on the tongue and buccal mucosa, which will progress to ulcerative vesicles
EXANTHEM (papulovesicular) – occurs 1-2 days after oral lesions
Differential – herpangina, Stevens- Johnson syndrome
Treatment – maintain hydration, cool liquids, avoid spicy food, rest
Topical aluminum hydroxide/ magnesium hydroxide gel with diphenhydramine applied to painful
lesions Topical anesthetics – Kank A, Orabase
Resolution with 7 days
STREP PHARYNGITIS – An acute inflammation of pharynx/tonsils, associated with crowding (school)
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
exidate, malaise
Strep: cervical adenopathy, fever >102F, no cough or nasal congestion, petechiae on soft palate, “Beefy Red”
tonsils, “sandpaper” rash (nose, neck and torso), abdominal pain, headache
Suggestive of viral : conjunctivitis, nasal congestion, cough, diarrhea
When cough - almost always exclude Streptococcus
Tests – rapid strep test
CBC: WBC shift to left
Monospot if mono suspected
Treatment: gargling with salt water, change toothbrush, incubation period 2-5
days PCN – one IM or 10 days treatment PO
First generation cephalosporins – 10 days treatment
MIDTERM STUDY GUIDE: PART-1
TOPICS Covered
o Chalazions
o Blepharitis
o Conjunctivitis
o Hand-foot-mouth syndrome
o Strep pharyngitis
o Kawasaki disease
o Rheumatic fever
o Milia
o Port-wine stain/Nevus flammeus
o Salmon patch
o Café-au lait spot
o Impetigo
o Molluscum Contagiosum
o Verruca Vulgaris
o Herpetic Whitlow
o Hemanginoma
o Otitis media
o Otitis Externa
CHALAZIONS – Benign, chronic lipogranulomatous inflammation of the eyelid
Causes – blockage of the meibomian cyst
Risk – hordeolum or any condition which may impede flow through the meibomian gland. Also mite species that
reside in lash follicles
Assessment – PAINLESS, NOT INVOLVING 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 indicated because chalazion is granulomatous condition, if secondarily infected
consider SULFACETAMIDE, ERYTHROMYCIN
Follow up – 2-4 weeks, if still present after 6 weeks follow up with ophthalmologist
,NR 602 midterm study guide graded A
BLEPHARITIS – Inflamation/infection of the lid margins (chronic problem)
2 types – seborrheic (non ulcerative) : irritants (smoke, make up, chemicals)
s&s – chronic inflammation of the eyelid, erythema, greasy scaling of anterior eyelid, loss of
eyelashes, seborrhea dermatitis of eyebrows and scalp
Ulcerative- infection with staphylococcus or streptococcus
s&s – itching, tearing, recurrent styes, chalazia, photophobia, small ulceration at
eyelid margin, broken or absent eyelashes
● the most frequent complaint is ongoing 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 – antistaphyloccocal antibiotics BACITRACIN, ERYTHROMYCIN 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 of conjuctiva
Bacterial (PINK EYE) – in peds bacteria is the mosts common cause, contact lens, rubbing eyes, trauma,
S&S – purulent exudate, initially unilateral, then bilateral
Sensation of having foreign body in the eye is common
Key findings – redness, yellow green, 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 – profuse tearing, mucous discharge, burning, concurrent URI, enlarged or tender preauricular nose
Antihistamines/decongestant
Improvement, self limiting, 7-14 days
,NR 602 midterm study guide graded A
Chlamydial – chlamydia trachomatis
S&S – profuse exudate, associated with genitourinary symptoms, 1-2 weeks after birth
Gonococcal – 2-4 days after birth, most concern can cause blidness
PO azithromycin, doxycycline (tetracyclines increase photosensitivity, don’t use in pregnancy)
Improvement 2-3 weeks
Allergic – IgE mast cell reaction, environmental, cosmetics
S&S – marked conjuctival edema, severe itching, tearing, sneezing
Topical antihistamine or topical steroids
Improvement 2-3 days
Chemical –thimerosal, erythromycin, silver nitrate
S&S conjuctival erythema, 30 minutes afer prophylactic antibiotics drops
Avoid contact
Can consider steroids
Conjunctivitis never accompany vision changes
Diagnostic studies: swap and scraping must be done, gram and Giemsa staining, ELISA, PCR testing, newborn < 2
weeks needs to be tested for gonorrhea
Non –pharm – clean towels, change pillows, warm compress, no contacts, no eye make up – mascara
Gonococcal conjunctivitis: newborn – give Ceftriaaxone IM once (don’t give if hyperbilirubinemia,
Non-gonococcal – erythromycin 0.5% ointment
Consider fluorescein staining if abrasion suspected
CDC recommends prophylactic administration of antibiotic eye ointment (ERYTHROMYCIN) 1 hour after delivery
Refer to ophthalmologist if herpes, hemorrhagic conjunctivitis or ulcerations present
May return to work/school 24 hours after topical
HAND-FOOT-AND-MOUTH DISEASE – HIGHLY CONTAGIOUS, viral illness
clinical entity evidenced by fever, vesicular eruptions in the oropharynx that may ulcerate and a maculopapular rash
involving hands and feet, the rash evolves to vesicles, especially on the dorsa of the hands and feet. Last 1 to 2
weeks.
lesions appear on the buccal mucosa, palate, palms of hands, soles of feet and buttocs
, NR 602 midterm study guide graded A
most common cause – COXSACKIE A
16 common in children <5
S&S – low grade fever, malaise, abdominal pain, enlarged anterior cervical nodes or submandibular
Oral – small red papules on the tongue and buccal mucosa, which will progress to ulcerative vesicles
EXANTHEM (papulovesicular) – occurs 1-2 days after oral lesions
Differential – herpangina, Stevens- Johnson syndrome
Treatment – maintain hydration, cool liquids, avoid spicy food, rest
Topical aluminum hydroxide/ magnesium hydroxide gel with diphenhydramine applied to painful
lesions Topical anesthetics – Kank A, Orabase
Resolution with 7 days
STREP PHARYNGITIS – An acute inflammation of pharynx/tonsils, associated with crowding (school)
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
exidate, malaise
Strep: cervical adenopathy, fever >102F, no cough or nasal congestion, petechiae on soft palate, “Beefy Red”
tonsils, “sandpaper” rash (nose, neck and torso), abdominal pain, headache
Suggestive of viral : conjunctivitis, nasal congestion, cough, diarrhea
When cough - almost always exclude Streptococcus
Tests – rapid strep test
CBC: WBC shift to left
Monospot if mono suspected
Treatment: gargling with salt water, change toothbrush, incubation period 2-5
days PCN – one IM or 10 days treatment PO
First generation cephalosporins – 10 days treatment
