DON'T (PANCE) PANIC

Teaching to Learn

[pancepanic]

Patent Ductus Arteriosa

[pancepanic]

Fast Facts

Intussusception associated with Henoch­ Schonlein purpura is virtually always what type of intussusception?

Ileal-ileal!

However, ileocecal is the most common type of intussusception overall (lead point ileocecal valve)

[pancepanic]

Kawasaki’s Disease

This is a necrotizing vasculitis that is believed to be caused by a virus.

Causes Coronary Artery Aneurysms

Also pericarditis, myocarditis, AMI

MC in asian babies (under 5)

Symptoms of Fever (5+ days) and Creams

Conjunctivitis (BL)

Rash (desquamation)

Edema

Adenopathy (cervical)/ Anemia (normocytic, normochromic)

Mucous Membranes (Strawberry tongue)

Sterile Pyuria

Treatments

IVIG

ASA (high does lowers chance of arterial aneurysm)

In children the ASA + virus can cause REYE’S SYNDROME

Reye’s syndrome = virus + salicylate (ASA/Peptobismol)

Vomiting/HA/Seizure/lethargy

ENCEPHALOPATHY w/elevated liver enzymes

Low blood sugar, high ammonia + Acid

KAWASAKI DUDES! Surfers get fevers from being in the sun 5 days a week and they need to cool down with drinks of CREAM. They’re out on the waves to heal their broken hearts.

Reye is youngest surfer on the beach and he got a swollen head thinking he was the best. He took some ASA for the headache and ended up hurling his lunch of liver!  Not cool dude.

[pancepanic]

Fast Facts

The Anterior Fat Pad Sign or “sail sign” means 2 different things in adults and in children. What fx are associated with this sign in adults and which one for children?

In a NONDISPLACED FX, the sail sign/anterior fat pad means a supracondylar fracture in children and a radial head fracture in adults. 

Children who want to sail around the world are thought of as SUPRAheros. Adults who want to do that are RADIcAL and touched in the HEAD.

[pancepanic]

Fast Facts

The proximal humerus fracture is a common pathological fracture site of what type of cancer?

Metastatic Breast Cancer

There’s nothing humerus about breast cancer, it’s actually a topic that’s close (proximal) to my heart.

[missysuehanson]

[pocket-pa]

Loving Picmonic

It’s free and it seems like a fun way to reveiw

#Vitiligo the Vampire Tiger

[pancepanic]

SKIN BUGS

(Like coke bugs but real)

Tinea

Capitus (head) treat with griseofulvin FIRST then itraconazole or tinabinafine

Boggy kerion and alopecia common

Crusis (pubic)/corpus(body)/pedis(feet) all get treated with topical zoles first then griseofulvin if that doesn’t work

Annular lesions with central clearing

Oncomyosis (nails)  itraconazole or tinabinafine

SCABIES

Itchy burrows (linear papules) that are best seen on soles of feet (can’t reach there to scratch them off) but also in the intertrigous zones. Siblings often get them. Will see excoriations. Treat with permethrin.

Lice

Capitus

Nits are small white and scaly looking- use a permethrin shampoo for 10 minutes then a nit comb

Pubis

Permethrin Lotion for 8 hours

Corpus

Permethrin

Alternate treatments Lindane but it’s neurotoxic (HA/Seizures) so not for <2 or if they are pregnant

PINWORMS

Small round worms that transmit fecal-orally in kids

Itching in the perianal region at NIGHT

Scotch tape test to dx (tape on the AM)

Albendazole, Mebendazole, Pyrantel

(You ALL BEND over so I can dx your pinworms. ME BEND over? py I RAN and TELL you NO!) 

[pancepanic]

Fast Fact

What two diagnosis are typically associated with cafe au lait spots?

[pancepanic]

It’s Neurofibromatosis and Faconi’s Anemia!

[pancepanic]

Quick Quirks

Viral Exanthems 

Measles- 3Cs (coryza, conjunctivitis, cough) THEN 7 letters=7 days of brick red rash. 

Mumps- Mumps mean bumps on pumps (Parotiditis) Leads to UL oophritits/orchitis and acute pancreatitis.

Rubella- Rubarb goes well with blueberry muffin rash. Congenital TORCH infection that leaves you deaf, dumb (MR) and blind (cataracts). In older kids there are arthralgias and sunsensativity. Run around with Rubella and your joints ache.

Coxsackie- A) Hand-Foot&Mouth- RED spots in pharynx, Herpangia- white spots in pharynx with high fever. Also lesions on palms & soles. B) Pericarditis/Myocarditis/Pleura dynia+HA

Dermatitis Herpetiformis- Celiac disease’s way of extending (on extensor surface) her pain into the dermis. Treat with gluten free diet and dapsone

Roseola- Houston’s 103 degree heatwave (fever x3 days) will eventually grow roses from your toes to your nose (up from trunk to face)

[wnq-anonymous]

You act like it’s you against the world, but it’s really you against yourself.

Anonymous   (via wnq-anonymous)

[pancepanic]

FAST FACT

Roseola is the only dermatological infant viral exanthum to start on the trunk and spread to the face

Plant your roses and they will grow tall enough to smell them. They have to grow up past your trunk to your face.

Roseola is characterized by high fever (103-105) for 3-5 days then fever drops as rash appears.

[pancepanic]

Fast Fact

What two diagnosis are typically associated with cafe au lait spots?

[pocket-pa]

IMPETIGO

Bullous

STAPH infection of the skin that starts as reddness and becomes bullous. Bullea may rupture and have a varnished coating. These ruptured vesicles may be mistaken for cigarette burns. Treat with cephalexin.

Non-Bullous

STAPH or GAS (Group A Strep) infection of the skin that has papules, vesicles and pustules that becomes the pathopneumonic HONEY COLORED CRUSTS. Small patches can be treated with topical mupirocin. Larger need cephalexin. Cool compresses can help to remove the honey color crusts. 

Strep is more likely to have local lymphadenopathy

Winnie the Pooh is IMPatient (Impetigo)  for that honey (colored crusts)

Keep reading

[pancepanic]

Acne VULGARis

General

Infection of the sebaceous glands often associated with increased androgens, risks increase with male gender, puberty and Cushing’s syndrome. Drugs causing can include corticosteroids/anticonvulsants/lithium. Neonatal acne from maternal androgens (max 2-5 months)

Severity Criteria

Mild: Open comedones (blackheads)/Closed comedones (whiteheads)

Moderate: Pustules/papules with few nodules

Severe (Nodulocystic): Pustules/papules with MANY nodules

Treatments

Mild: Keratolytics (topical retinoids) +/- Benzoyl Peroxide

Makes you sun sensitive, SPF 15

Worse after 3 weeks then better after 6+ weeks

Moderate: Mild + Topical then Oral ABX

(erythromycin/clindamycin/doxycycline/minocycline/tetracycline)

Severe: Moderate +  Isotretionin/Retinoic Acid

TERATOGEN- -pregnancy test + 2 forms contraceptives 1 month pre and post

Increased risk depression

Differential

Peri-oral Dermatitis- No comedones, clearing around vermillian border

Acne Rosacea- face & neck only. MC in 30-50 with telangictasia/blushing along with papules. VASOVAGAL sensitivity (temp, alcohol, emotion)

Podcast: http://www.physicianassistantexamreview.com/dermatology-acne-to-spider-bites-a-pa-review-and-podcast/

[pancepanic]

Fast Facts

AC:DC as Vfib:Asystole

You’re part of ACDC? You FIB, I know my SYS TOLd mE.

AC currents are more severe because they cause muscle contraction, keeping people from letting go of the line. DC currents throw the person from the source. Lightening tends to ‘flash over’ people without causing deep damage. Always look for the entry and exit wound with an electrical injury!

[pancepanic]

Fast facts only for the next couple days! I’m ending my ER rotation and headed to pediatrics