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NEENT
The NEENT mind map clearly addresses primary aspects such as the nose, eyes, and throat, with each aspect having several levels discussing issues like nasal and lacrimal duct blockages. This graphical tool aids in information integration and idea stimulation by mimicking the radial structure of the human brain's neural network to enhance memory and information organization.
Edited at 2023-08-27 14:27:44
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HEENT
Nose
Rhinitis
Allergic
Chronic
Sinusitis
Epistaxis
Nasal polyps
Foreign body
Mouth
Dental caries
Cleft lip and cleft palate
Oral candidiasis (thrush)
Aphthous ulcers (canker sores)
Herpes
labialis (cold sore, fever blister)
simplex stomatitis
Hand, foot, and mouth disease
Herpangina
Throat
Acute nasopharyngitis (common cold)
Pharyngitis and Tonsilitis
Cervical lymphadenitis (cervical adenitis)
Retropharyngeal abscess
Epiglottitis (supraglottitis)
Ear
External otitis
P aeruginosa
rx: ciprodex otic drops
AOM
2nd most common (80%), next to URI
b: S. pneumoniae
v: RSV
suppurative, tympanocentesis ENT
residual OME ~6 weeks
tx: amox/clav with concomitant
OME
25-35% of all OM
most common cause of
monitor hearing
PET in 1-3 yo w/OME x4-6 months w/hearing loss
Tympanostomy tubes (PE tubes)
Chronic/Acute Perforations
central vs peripheral (higher risk for
P aeuroginosa
tx: 14 day PO abx, 7 day OTIC drops
most heal in 2 weeks
Mastoiditis
CT scan
uncommon
2e to OM
60% occur bw 6-24 months of age
Cholesteatoma
CT scan
tx: surgical excision
stratified squamous, serous OM
pearly white, opacity
Hearing Loss
mild 15-30 db mod 30-50 db sev 50-70 db profound 70 db+
conductive
75% of all children have x1 AOM w/this
sensorineural
moderate to profound
congenital causes: TORCH, CMV, rubella
autosomal dominant
acquired: meningitis, mumps, measles; NIHL, head trauma
Eye
Conjunctivitis
newborn (ophthalmia neonatorum)
Gonorrhea
Does transmission of NG and CT only occur during vaginal birth?
gram - intracellular diplococci
propylactic eye ointment
tx: ceftriazone, cefotaxime, ceftazidime (except in newborns with hyperbili)
Chlamydia
intracytoplasmic inclusion
tx: erythro PO sulfas (trimethoprime, sulfamethoxazole after neonatal period
pneumonia tx: erythro PO 50mg/kg/day Q6H x 14 days
most common
HSV
ocular dendritic ulcers
rare, but may lead to vision loss
tx: acyclovir PO
Other bacteria (most commonly: H. influenzae S. pneumonia)
tx: topical abx, warm compress
childhood
Opth referral if: not responsive to tx after 2-3 days loss of vision, pain, photophobia severe or corneal involvement
bacterial
S. aureus S. pneumoniae H. influenzae M. catarrhalis
conjunctivitis-otitis
viral
adenovirus 3, 4, 7
less common: herpes, varicella
allergic/vernal
seasonal, mold, animal dander
cobblestone-like papillary hypertrophy
Dacryostenosis
blocked tear ducts
spontaneously resolves until 12 months
most common lacrimal disorder in infats
Palpebra (eyelids)
Chalazion
sterile
nontender
conjunctival midportion, often midupper
Hordeolum (stye)
bacterial (S. aureus)
children/adolescents
tender
Blepharitis
bilateral inflammation
S. aureus
ulcers
dry
can lead to ectropion
Cellulitis
Orbital
older, 12 years of age
requires hospitalization
Periorbital
younger mean, age 2 years
outpatient management with PO amox/clav or cefixime (after initial IM of cetriaxone) if >1 year and early stages
Cataracts
lens opacity, protein breakdown
Glaucoma
optic nerve, eye pressure
Strabismus
Nystagmus
Refractive errors
Anisometropia
Amblyopia (lazy eye)
Blindness (amaurosis)
Retinoblastoma
Eye injuries
Head
Microcephaly
Macrocephaly
Hydrocephalus
Caput succedaneum
Cephalhematoma
Craniosynostosis
Dermatology
Bacterial
S. aureus/S. pyogenes
cellulitis
can progress to necrotizing fasciitis (surgical emergency)
preciptated by insect bite/trauma
localized infection; deeper dermis
epidermal to subQ invasion of surface -
streptococci
cefazolin, amox, nafcillin
same as cellulitis
H. influenzae
Augmentin
S. aureus
dicloxacillin
MRSA
Bactrim, clindamycin
tender, red, edematous + fever, chills, malaise
more severe - facial, perio-orbital, orbital
dx: BC
tx:
inpatient for face and eye involvement
impetigo
precipitated by insect bite/trauma
itchy, tender, blister, moist, erythematous macules to pustules; "honey-coloured" crust
predominantly on face, occ. perineum
S.aureus, streptococci
<6 y.o.
bullous - infants
erythema, erupted pustules and vesicles; smooth, shiny
non-bullous - 2 to 5 y.o.
erythema, erupted vesicles; honey coloured, epidermal erosion
autoinoculable
regional adenopathy
dx:
BC
tx:
several compress of Burrow's solution
abx
TOP - mupirocin
PO -
staphylococcal scalded skin syndrome
skin lysis, sloughing, erythematous - skin loss
sloughing at stratum granulosum
toxin-mediated, systemic bacterial infection
S. aureus
more common in neonates and infants
bright-red, painful rash (pain on pressure)
pronounced around eyes, mouth, neck, underarms, elbow, groin, and knees
+systemic - abrupt onset fever, irritability, malaise
3-10 day incubation
dx:
BC
culture secretions
tx:
inpatient for all neonates - IV abx, fluid and lytes
outpatient
PO abx (S. aureus - cefazolin, dicloxacillin)
anti-fever/-pain
in pilosebaceous unit
acne vulgaris
breakdown of follicle; cells combine ith sebum and form plug
Corynbacterium acnes enyzme mix w/trapped debris
face, neck, chest - cyclic
mild - open (black-oxidized sebum)/closed (white-sebum+follicile cells) comedones
benzoyl peroxide
moderate - more numerous, covering large areas
+ pustules (incl. sebum+follicile cells+WBCs)
benzoyl peroxide
TOP tretinoin
severe - more numerous, covering larger areas
+ erythema w/papules and pustules
+ nodules and cysts (deeper dermal lesions)
benzoyl peroxide
TOP tretinoin
abx
TOP - clindamycin
PO - tertacycline, doxycycline, minocycline
no PO clindamycin (GI effects)
affects 70% teens
scarring
picking + eruption of large cysts
dx:
none
tx:
TOP exfoliates/comedolytic preps
consider isotretinoin (severe, unresponsive & persistent)
teratogenic
w/BCP for females
educate
may be worse prior to improvement
will take months
must be cosnistent
monitor Q4-6 wks
folliculitis and furuncles
tender/warm papular/pustular lesions
face, neck, scalp, and buttocks
folliculitis
superficial - upper follicle
furuncles
deeper - down the follicle and into dermal appendages
S. aureus, strep
males
often occur w/tinea
dx: culture
tx:
antimicrobial soap
warm, moist compress
TOP abx (mupirocin)
PO abx
S. aureus
dicloxacillin, cephalexin
streptococci
penicillin, cephalosporin (erythro if allergic to penicillin)
MRSA
Bactrim, clindamycin
Viral
herpes simplex/common cold sore
lip/oral 'fever blisters'
may be preceded by mild itching, tingling, pain, and burning
contagious
lip: erythema, grouped vesicles
Subtopic
s
Burrow's compress
TOP antivirals (acyclovir)
oral: edema, painful white ulcerated patches
halitosis
avoid spicy and acidic foods
drink cool, bland fluids
anesthetic mouth rinse (lidocaine, diphenhydramine)
fever, malaise, sore throat
last 10-14 days
stages
initial - severe, lasts, painful
dormant - lives on ending of select nerves, asymptomatic
2e infectious - activated by stress, illness, fatigue, sun, menses, dental procedures
most caused by staphylococcus
HSV 1 (most common) + HSV 2 (oral sex)
dx:
Tzanck smear (confirms multniculear cells)
culture
tx:
recurrent disease
PO acyclovir, famciclovir, valacyclovir (at 1st prodrome - tingling)
2e infection
PO abx (dicloxacillin, cefadroxil, cephalexin)
educate
avoid kissing
wash hands
avoid sharing personal items
mollolscum contagiosum
self-limiting
poxvirus
spread via direct contact + autoinoculation
contagious
face, axillae, abdomen, arms
small waxy, firm papules
pinkish-white, skin-coloured
mild pruritus
occ. genital area
r/o child maltrx
seen in
children/teens
atopic derm, HIV/AIDS
incubation 2-8 weeks, up to 6 months
may be present up to 2-3 yrs if left untreated
dx: often not required
Wright/Giesma stain of papule (intracytoplasmic inclusions)
tx:
none are cures
tincture of time
curettage - expedient (not on face d/t scarring)
TOP keratolytics (not near eyes)
tretinoin cream
Cantharidin
2e bacterial - TOP abx (mupirocin)
verruca vulgaris (warts)
self-limiting
HPV
spread via direct/indirect contact + autoinoculation
contagious
fingers, palms, soles of feet
firm, raised, well-circumscribed, smooth to irregular, singular or multiple hyperkeratotic papules
common: gray, brown, skin-coloured (hands/fingers)
flat: skin-coloured, smooth, round, multiple, elevated (face/limbs)
plantar: skin-coloured, irregular, single/multiple flat
virus enters via minor trauma
occurs in 10%, school-aged highest incidence
incubates 2 months - 2 yrs
frequently recur
dx: excision, histologic exam
tx:
no cure
TOP keratolytics
OTC wart preps
+waterproof plastic tape
excision (except on face)
2e bacterial - TOP abx (mupirocin)
consider congenital/acquired immunodeficiency if no resolution/widespread
Fungal
tinea capitis
superficial dermatophyte
incubation period 10-14 days
Tichophytin tonsurans (90%)
attach to epidermis of scalp + multiply in stratum corneum - superficial
spread - direct/indirect contact (hats, combs; pets)
rx:
hot, humid climates
boys
darker-skinned
itchy, sl. raised, round/angular scaly
broken hair/alopecia - "black dots"
pustules, papules w/honeycomb crusts
dx:
Wood's lamp (limited use)
KOH scraping to confirm hyphae + spores of dermatophytes
tx:
PO antigunfal (Griseofulvin; ultramicrosize formulation - best absorption) x 8 weeks
*TOP antifungal ineffective*
shampoo 3x/week w/selenium sulfide/ketoconazole
school okay unless tx not followed or refused
tinea corporis
superficial dermatophyte
"ringworm"
heal centrally, spread peripherally
Tichophytin rubrum, T. mentagrophyte, M. canis (pets), Epidermophyton floccosum
attach to epidermis of face and body + multiply in stratum corneum - superficial
spread - direct/indirect contact (others, animals, shower stalls, benches)
hot, humid climates
itchy, sl. raised, round/angular scaly w/pink borders
dx:
Wood's lamp - M. canis
KOH scraping
dermatophyte test medium (DTM)
tx:
antifungal
TOP antifungal x 8 weeks
clotrimazole, miconazole, ketoconazole
PO antifungal for extensive, recurrent
Griseofulvin
shampoo 3x/week w/selenium sulfide/ketoconazole
school okay unless tx not followed or refused
tinea cruris
superficial dermatophyte
"jock itch"
E. floccosum, T. rubrum, T. mentagrophytes
attach to epidermis + multiply in stratum corneum - superficial
groin, upper thighs, inguinal folds
spread - direct/indirect contact (others) + sexual contact
painful, itchy, sl. raised scaly patches + occ. blisters + red or brown
possible lichenification
rx:
hot, humid climates
adolescents
athletes
obese children
males
dx:
KOH scraping
DTM
tx:
TOP antifungal x 4-6 weeks
clotrimazole, miconazole, ketoconazole
PO antifungal for extensive, recurrent
Griseofulvin
avoid public pools, avoid tight clothes, launder after eacg use
tinea pedis
superficial dermatophyte
"Athelete's foot"
E. floccosum, T. rubrum, T. mentagrophytes
attach to epidermis + multiply in stratum corneum - superficial
foot, most commonly plantar and lateral, 3rd-4th toes
spread - direct/indirect contact (locker rooms)
raised red vesicles
stinging or pain if cracks between toes
tx w/compresses of Burrow's solution
dystrophy of nails (yellow, periungual debris)
rx "
dx: "
tx:
PO/TOP antifungal "
absorbant antifungal powder
Dermatitis
atopic dermatitis
extensors
altered skin barrier function d/t elevated IgE
10-15% of children
atopic triad (50%), up to 25% continue into adulthood
worsens w/sweating and extremes in temp
infants, acute - 2 wks-6 m. o., resolve by 3 yrs
"alergic shiners", Dennie's creases
dx: skin scraping
r/o scabies
tx:
2e infection: pustules
PO abx (bactrim, cephalexin), TOP abx (mupirocin)
oral antipruritic (diphenhydramine)
TOP steroids (hydrocrotisone)
rehydrate w/daily lukewarm baths, wet compress, cream emoollients/lubrictants
avoid irritation via perfumes, bleach, chlorine, wool, feather, polyester
maintain cool temp, increase humidity
contact dermatitis
allergic
Type 1 HSR
initial - delayed several days
reexposure - within 24 hrs
ex: perfumes, top meds, animal, plastics, plants, metals
symptoms: erythema, edema, pruritus; papules, vesicle and bulla
direct contact
chronicity = hyperpigmentation and lichenification
dx: skin testing after acute stage
tx:
avoid contact w/allergen
cool compress of Burrow's solution [aluminium triacetate]
steroids (TOP/PO hydrocortisone) to reduce inflammation, immune response, and pruritus (+diphenhydramine)
refer to derm if does not improve in 2 days
irritant
Type 2HSR
chemical irritants - soap, bleach, diaper cleansing tissues
excessive contact w/urine, feces; lax hygiene
erythema, scale, vesicles, papules, crusts, eorsions, and ulcerations
95% of all infants
peaks 9-12 months
Candida rash - fiery red papular lesions in folds and genitals; may have oral thrush
tx:
2e infx: pustules
TOP abx (mupirocin)
mild erythema - zinc oxide, vaseline
erythema w/papules - TOP hydrocortisone
severe erythema + edema w/papules, vesicles, ulcerations - wet dressing, TOP abx
Candida/monilial - TOP nystatin
avoid occlusives (diapers, plastic pants)
expose to air
increase PO fluids (dilutes urine)
water <1 yr
cranberry juice for older child
wash diaper with mild soap and water
use vaseline at each diaper change
refer to derm if no improvement in 2-3 days
seborrheic
scalp and face (sebum-rich areas)
cradle cap (newborns)
yellow crusts, greasy scales
tx: shampoo, nonperfumed, mineral oil w/brushing, hydrocortisone
dandruff
white flakes and greasy scaling, mild underlying erythema
tx: antiseborrheic shampoo, mineral oil, hydrocort
overproduction of sebum, hormonal stimulation
spring and summer
Papulosquamous
pityriasis rosea
"Herald" Patch, Christmas tree pattern
mild scaly, hypopigmented and hyper-pigmented lesions
trunk, upper arms, upper thighs
older children
viral - prodrome of malaise and low-grade fever
dx:
KOH to r/o fungal infx
VDRL to r/o syphilis
tx: calamine, antiprurtic, cool bath, low potency steroid creams
self-limiting, resolve in 3-4 months
psoriasis
autoimmune etiology
1/3 of children
erythematous plaques w/silver scales
vulgaris (lg; extensors)
Koebner's response; trauma
guttate (sml; trunk, tighs, arms)
strep
overproduction and rapid migration of epithelial cells (3 days vs 28 days)
1 in 5 have psoriatic arthritis
+ FH
nails: dystrophic, thickened, pitting, ridged, 'oil spots'
dx:
tx: topic steroids, mineral oil, moisturizers
Pityriasis Alba
acquired
unknown etiology
hypopigmented, finely scaled macules
cheeks
3-12 y.o.
KOH test
Disorders of Pigmentation and Melanocyte
café au lait spots
light- to medium-brown macules
increased pigmentation of melanocytes
dark>light-skinned
present at birth, may develop any age
6+ lesions, lesions >1.5cm = risk for neurofibromatosis/Albright syndrome
refer to dermatologist
dermal melanocyte
blue-black/ gray macules
migrating spindle-shaped pigmented/melanocye cells deep in dermis
often dorsal: sacrococcygeal, buttocks, lumbar; shoulders, upper back, limbs
in 90% of all dark-skinned infants
not on palms or soles
most fade in childhood/adolescence
malignant melanoma
UVB-induced DNA damage to melanocyte
spreads via lymph
ABCD - itching, bleeding, tenderness
higher risk
severe sunburn <10 y.o.
females up to 40 y.o.
increasing incidence
90% survival rate w/localized condition
most common cause of death from skin cancer
skin biopsy
albinism
congenital; males=females
enzyme defect (tyrosinase)
melanin not secreted
total-type 1: skin, hair, retina
partial-type 2: localized; area, hair, eyes
vitiligo
acquired autoimmune destruction of melanocytes
localized
segmented - 2 dermatomes
generalized - >2 dermatomes
assocaited w/ DM, Addison/s, thryoiditis
onset prior ot 20 y.o.
permanent w/o repigmentation
Vascular Lesions
salmon patch
benign, flat salmon-coloured
overgrowth of BVs within dermal layer
eyelids, neck, glabella, and/or occiput
gradually fade and diappear
eyelid - 3 to 6 months
nape of neck - may persist into adulthood
other lesions - resolve by 7 y.o.
port-wine stain
benign, irregular, flat dark-red to purple
proliferation of dilated capillaries in the dermis
permanent (become thickened and raised in adulthood)
face: Sturge-Weber syndrome (cover half/bilateral)
r/o
extremities: hypertrophy of soft tissue and bone
back: defects in spinal cord/vertebrae
rare, 0.4% of newborns
capillary hemangioma
bright red/blue-red nodular tumours; rubbery and rough
proliferation of capillary endothelial cells (superifical/deep)
head and face
common in girls, light-skinned, preterm infants
most growth first 6 months
gradual reduction in 9-12 months
50% cleared by 5 y.o.
90% cleared by 10 y.o.
remainder clear in adolescence
complications
eye/orbital area: visual disturbances
head and neck: subglottic? airway obstruction
heart: cv disturbance via compression
lesions may ulcerate as they involute
Newborn
cutis marmorata
transient
mottling, lacy red-blue appearance
exposure to cold
rx: T21, preterm infants
occur in 50% of all newborns
erythema toxicum
varied: erythematous macules, wheals, vesciles, papules
often in term/post-term infants
onset at birth or 24-48hrs
fade 5-7 days
often noted on trunk, spares palms and soles
milia
firm, yellow-white papules 1-2mm
Epstein's pearls (oral)
resolve in two weeks
Misc
drug erruptions
hypersensitivity rx, histamine
sulfates
pencillin
barbiturates
dilantin
morbilliform generalized rash
extreme pruritus
rash begins on trunk and moves to limbs
from macules - papules --> confluent
tx:
PO steroids (prednisone)
PO anthistamines
nocturnal: hydrozyzine, diphenhydramine
non-sedating: OTC loratidine, cetirizine
erythema multiforme
infectious (enteroviruses, M.pneumoniae, HSV), drug (sulfates, pencillin, barbiturates), or food
minor
spontaneous resoluton in 2-3 wks
pruritus and pain
tx:
cool compress
PO anthishitamines (See above)
PO analgesics
maintain hydration
TOP anesthetics and mouthwashes for oral lesions (lidocaine)
major
systemic involvement
rash develops 2-3 days after systemic symptoms
sudden onsent prodrome (high temp, malaise, weakness)
may progress to severe stage involving resp, renal, GI systems
tx:
life-threatening: immediate derm referral and hospitalization
- macular --> papular, vesicular, erosive, petechiae - targetoid (both)/herald (major) lesions: necotric/vesicular center, pale middle macular ring, outer red peripheral ring
dx:
chest xray for M. pneumoniae
Tzanck HSV
skin biopsy (major)
urticaria (hives)
hypsersentivity
pale/skin-coloured skin lesions
wheals 1-15cm
blanch w/pressure
release of histamine via
food, temp changes, viral infections
vibrations, scratching, emotional stress, insect bites, materials/fabrics
tx:
Burrow's cold compress
TOP steroids (hydrocortisone, triamcinolone)
PO steroids (prednisone) for severe
PO antihistamines for nocturnal pruritus
Insect
conditions
common bites
bugs
mosquitoes
fleas
chiggers + bed-bugs
smaller, redder, more plentiful
vectors for disease (malaria)
itching = sensitivity to insect's saliva may last 5-7days
variable pain
papules, wheals
excoriation w/intense pruritus
2e bacterial - pustules
dx:
culture pustules
tx:
treat pruritus
cool compress
TOP histamines (hydroxyzine, diphenhydramine)
PO antihistamines (hydroxyzine, diphenhydramine)
reduce inflammation and immune response
TOP steroids (mupirocin)
treat 2e infection
TOP abx (mupirocin)
PO abx if extensive, recurrent (cefadroxil, cephalexin)
educate
spider bites
p. 196
wound
local + systemic
many are harmless, but 2 venomous spiders = severe toxic reactions
Black widow - mature female (male cannot penetrate skin, smaller); hourglass
can progress to shock, coma, death
muscle spasms, HTN, tachycardia, diaphoresis
Ohio, South, Southwest, West Coast
dry, warm, dark (grass, sheds, basements)
diff dx: appendicitis, tetanus
Brown recluse - mature, gray, red, pale brown; violin
flu-like
Midwest, South
trunks, carperts, old shoes, shelves, crates
diff dx: diabetic ulcers, SJS
infants and younger children
tx:
Black widow/ Brown recluse = hospitalization + refer to derm
both can lead to neruo, CV, and renal involvement
others = cold compress, PO antihistamines, monitor for hypersensitivity
insect stings
hypersensitivity to venom
mild in 90%
anaphylaxis in 7%
typical reaction (up to 24hrs)
nausea, abdo pain
sneezing, coughing
itching
erythema and edema
tx: remove stinger (dont squeeze), PO antihistamines, monitor for below
anaphylactic reaction
early - dizzy, swelling of lips and throat, difficulty breathing/swallowing
late - weakness, collapse, confusion, coma
tx: EPI, hospitalization, derm referral
infestations
scabies
highly contagious parasitic mite
Sarcoptes scabiei (itch mite) intense itching
gravid female mite burrows into stratum corneum to lay ova
hatch in 4-14 days
major infestations 15-30 years
red bumps, blisters, pustules
presentation/tx
infants - red-brown papules, vesicles
head, neck, palms, soles
tx: permthrin 5%
older children and teens - red papules
finger webs, wrists, elbows, axillae, waist, groin, umbilicus, knees, ankles
tx: permethrin 5%; lindane (>110 lbs), crotamiton 10%, sulfur in petrolatum
small burrow marks (may be obliterated by scratch marks)
fine gray/skin-coloured 2-8 mm linear curved burrows w/small papule
regional adenopathy
2e infection: pustules
dx:
skin scrapings of burrow or papule
2e infection: culture of pustule
tx:
bathe, dry skin, TOP meds.
TOp steroids - hydrocort
PO antihistamines (hydroxyzine, triamcinolone)
2e bacterial infx: TOP abx (mupirocin), PO abx (dicloxacillin, cefadroxil, cephalexin)
hot water, hot dryer; unwashable items in plastic bags x 1 week
pediculosis
highly contagious parasitic louse
capitis
humanus
pubis
Caucasians
louse do not fly or jump
itchy, flakes, blotches, macular/papular lesions
dx: identify live louse
tx:
TOP antiparasitics (permethrin, malathion, ivermectin)
*two treatments recommended*
2e: TOP mupirocin
non-pharm
head - fine-tooth comb
eyelash - vaseline
trreat infested family members
expect residual pruritus and scaling - avoid 'no nit' return to school policy
Burn
burns
degree
1st - superficial, epidermis
red, swollen, dry, tender
1st/2nd = erythema, edema, moist, vesicles/blisters, sensitive to touch and air
2nd - partial-thickness, to deep dermis
white, dry, loss of sensation
3rd - full-thickness, to dermal appendages
white, brown, black, swollen, dry
lack sense of touch, pain, temp
extent
minor
<10% + 1st degree/ <2% + 2nd/3rd degree
major
10%> + 1st degree/ 2%> + 2nd/3rd
hands, feet, eyes, ears, face, perineal (regardless of extent)
cells unable to protect, store lytes, sense, or function as normal skin cells
3rd leading cause of death
toddlers and males
in kitchen in later afternoon during dinner prep
10% thought to be intentional in infant to young child
diff dx: child maltreatment
dx:
electrolytes
culture
tx:
inpatient
major burns
suspected abuse
esophageal/airway burns
injuries (fractures)
outpatient
2nd degree if <10% of BSA
3rd degree if <2% of BSA
cool compress
PO pain control (tylenol, advil)
increase PO fluids
topic emollients to repair and maintain skin barrier (vaseline)
sun prevention
SPF>30 twenty min prior (avoid in infants < 6 months)
same as sunburns
open blistered areas - top abx (mupirocin, silver except for face)
avoid excision of vesicles/blisters
sunburns
inflammatory, increased blood flow
increased melanin
redness, swelling, blisters, tenderness
fatigue, chills, headache post exposure
degrees
1st - erythema, tenderness
2nd - +edema, vesicles/blisters
(young child) systemic: malaise, fever, headache
3rd - increased 2nd intensity
systemic: malaise, fever, headache
epidermal cells scale and desquamate in 3-7 days
tx:
avoid warm/hot baths
GI
Acute abdominal pain
Intussusception
'currant-jelly stools'
Appendicitis
Functional disorders
Abdominal pain
Dyspepsia
Abdominal migraine
IBS
colon
disturbed intestinal motility
Constipation
Hernia
Malabsorption
Chronic diarrhea
IBD
UC
superficial: mucosal/submucosal
bloody diarrhea + LLQ pain
rectum to cecum
continuous
crypt abscess w/neuts
img: 'lead pipe sign'
complications
toxic megacolon
carcinoma (via screening colonscopy)
smoking protects against UC
CD
deep: knife-like fissures
non-bloody diarrhea + RLQ pain
mouth to anus
skip lesions
terminal ileum
'cobblestone mucosa'
img: 'string sign'
smoking increases risk for CD
Pinworms
Gastroenteritis
Pyloric stenosis
projectile nonbilious vomiting
GERD
acid reflux d/t decreased tone of LES
Liver
Hepatitis
viral: hepatitis, EBV, CMV
sx: jaundice
NAFLD
Allergy
Main Topic
Main Topic
Main Topic