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End of Rotation: Pediatrics > EENT > Flashcards

EENT Flashcards

1
Q

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A

conjunctivitis

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2
Q

What is conjunctivitis?

A
  • Inflammation of the conjunctiva
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3
Q

What are the types/causes of conjunctivitis?

A
  • Three organisms: non-typeable H. influenza, Strep. Pneumonia, S. aureus
  • Highly contagious, outbreaks can occur
  • Transmission is via direct contact or via fomites. Autoinoculation, from one eye to the other, usually via the fingers is typical.
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4
Q

What are the signs and symptoms of bacterial conjunctivitis?

A
  • Include a acute onset of mucopurulent discharge from both eyes, red eyes, and edema of the conjunctiva
  • Patients may have mild decrease in visual acuity and mild discomfort. The eyes may be “glued” shut on awakening.
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5
Q

How is bacterial conjunctivitis diagnosed?

A

• Common pathogens: Gram stain should show the presence of polymorphonuclear cells (PMNs) and a predominant organism, although this is not routinely done

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6
Q

How is bacterial conjunctivitis treated?

A
  • Attention to hygiene, including hand washing and avoidance of contamination, should be stressed
  • Topical antibiotics: sulfonamides, fluroquinolones, and aminoglycosides (drops are more effective than ointment)
  • For rare pathogens treatment may also require concurrent systemic antibiotics
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7
Q

What are the types/causes of viral conjunctivitis?

A
  • Adenovirus type 3, 8 or 19 and coxsackievirus are typical causes. Adenovirus is the most common viral cause of conjunctivitis.
  • Highly contagious, transmitted by direct contact, usually via the fingers, with the contralateral eye or with the other persons
  • It can be transmitted via swimming pools
  • Adenovirus: pharyngoconjunctival fever- triad: pharyngitis, fever, and conjunctivitis
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8
Q

What are the signs and symptoms of viral conjunctivitis?

A

• Include watery, red eyes with pre-auricular lymph nodes. Conjunctivitis with lymph nodes: think viral etiology.

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9
Q

How is viral conjunctivitis treated?

A
  • Eye lavage with normal saline twice a day for 7-14 day; vasoconstrictor-antihistamine drops may also have beneficial effects
  • Warm and cool compress reduces discomfort
  • Includes supportive treatment with constant hand washing to prevent transmission.
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10
Q

What is the cause of allergic conjunctivitis?

A
  • Immunoglobulin E (IgE)- mediated reaction caused by triggers such as pollen or dust
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11
Q

What are the signs and symptoms of allergic conjunctivitis?

A
  • Include watery, itchy, red eyes with edema to the conjunctiva and lids
  • Pruritus and chemosis are common
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12
Q

What is the treatment for allergic conjunctivitis?

A
  • Includes removal of the trigger, cold compress, and anti-histamines
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13
Q

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A

Orbital cellulitis

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14
Q

What is orbital cellulitis?

A
  • Inflammation of the orbital tissues behind the septum

- Orbital cellulitis is postseptal

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15
Q

What causes orbital cellulitis?

A
  • Less commonly it results from trauma
  • The most common organisms are H. influenza, S. aureus, and S. pneumonia
  • Most common site: medial orbital wall
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16
Q

What are the signs and symptoms of orbital cellulitis?

A
  • Orbital cellulitis presents with ptosis, eyelid edema, exophthalmos, purulent discharge and conjunctivitis.
  • Examination will reveal fever, restricted range of motion of eye muscles, edema and erythema of the lids and surrounding skin and a sluggish pupillary response
  • Proptosis, ophthalmoplegia (painful extraocular motion), and decreased vision differentiate it from preseptal cellulitis
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17
Q

How is orbital cellulitis diagnosed?

A
  • Workup includes CBC blood cultures, and cultures of any drainage. WBC will be elevated
  • CT is recommended to determining the extent of disease. CT will show broad inflammation of the orbital soft tissue.
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18
Q

What is the treatment of orbital cellulitis?

A
  • Medical emergency requiring hospitalization, IV antibiotics, and surgical drainage if recalcitrant or recurrent.
  • Continue IV antibiotics until the fever subsides, then complete with 2-3 weeks of oral antibiotics
  • Recommended regimens include nafcillin and metronidazole or clindamycin, second or third generation cephalosporin, and fluroquinolones. If MRSA is suspected treat with vancomycin.
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19
Q

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A

periorbital cellulitis

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20
Q

What is periorbital cellulitis?

A
  • Inflammation of the eyelids and periorbital tissue anterior to the septum
  • Periorbital cellulitis is preseptal cellulitis
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21
Q

What causes periorbital cellulitis?

A
  • Extension of local infections including upper respiratory infection (URI), sinusitis, facial cellulitis, or eyelid infections.
  • Trauma: skin trauma is the most likely etiology
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22
Q

What are the signs and symptoms of periorbital cellulitis?

A
  • Erythema
  • Edema
  • No pain with extraocular movements
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23
Q

How is periorbital cellulitis treated?

A
  • Oral or IV antibiotics (e.g., ceftriaxone, clindamycin)
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24
Q

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A

Strabismus

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25
Q

What is strabismus?

A
  • Deviation or misalignment of the eye
  • Condition in which binocular fixation is not present
  • Strabismus can lead to vision loss (amblyopia)
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26
Q

How do we diagnose strabismus?

A
  • Corneal light reflex: the child looks directly into a light source and the doctor observes where the reflex lies in both eyes; if the light is off center in one pupil or asymmetric, then strabismus exists.
  • Alternative cover test: the child stares at an object in the distance and the doctor covers one of the child’s eyes; if there is movement of the uncovered eye once the other eye is covered, then strabismus exists. Reveals latent strabismus
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27
Q

What is the treatment for strabismus?

A
  • Strabismus may be corrected with eye exercises (patch therapy)
  • Prescription glasses may help if the strabismus is secondary to refraction
  • Eye muscle surgery may be necessary
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28
Q

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A

Otitis Media

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29
Q

What is otitis media?

A
  • Inflammation of the middle ear
30
Q

What causes otitis media?

A

Etiology:

  • S. pneumoniae
  • H. influenza
  • M. catarrhalis
31
Q

Why are kids more likely to get otitis media than adults?

A
  • The incidence of infection is higher in children because of their Eustachian tube anatomy:
    • Horizontal
    • Short in length
    • Decreased tone
32
Q

What are the risk factors for otitis media?

A
  • The incidence of otitis media is higher in: boys, children in day care, children exposed to secondhand smoke, non-breast fed infants, immunocompromised children, children with craniofacial defects like cleft palate, and children with a strong family history of otitis media.
33
Q

What is acute otitis media?

A
  • Eustachian tube dysfunction is the most important factor
  • A red eardrum in a crying child is normal; the most specific sign of acute otitis media is decreased mobility of the tympanic membrane.
  • The typical scenario involves a viral URI that leads to Eustachian tube dysfunction or blockage. A bacterial infection occurs with the subsequent build up of fluid and mucus.
34
Q

What are the signs and symptoms of AOM?

A

Signs and Symptoms:

  • Ear tugging
  • Ear pain
  • Fever
  • Malaise
  • Irritability
  • Hearing loss
  • Nausea and vomiting
35
Q

How is AOM diagnosed?

A
  • Diagnosis is made with a pneumatic otoscope- the tympanic membrane will have decreased mobility and will appear hyperemic and bulging with loss of landmarks. The ear canal and eardrum will also be erythematous.
36
Q

How is AOM treated?

A
  • Typically, the first line treatment antibiotic is Amoxicillin. Can also use Augmentin or Azithromycin. High dose can be used for cases most likely to be resistant.
  • Anti-pyretics: ibuprofen and/or acetaminophen
  • Topical anesthetic eardrops (e.g., benzocaine)
  • For healthy children > 2 years old with milder cases, watchful waiting for 24-48 hours is an option
  • Pneumococcal vaccine has reduced the incidence of AOM.
37
Q

xx

A

Allergic Rhinitis

38
Q

What is Allergic Rhinitis?

A
  • An IgE-mediated response to an allergen causing inflammation of the nasal mucosal membranes
39
Q

What causes allergic rhinitis?

A
  • It commonly occurs in children with other atopic disease (asthma, eczema, atopic dermatitis) and those with a family history
  • Allergic rhinitis in children may be a precursor for the development of asthma
40
Q

What are the signs and symptoms of allergic rhinitis?

A
  • Generally do not develop until 2-3 years of age
  • Symptoms may be confused with the common cold
  • Allergic Shiners
  • Allergic salute
  • Sneezing
  • Watery nasal discharge
  • Red, watery eyes
  • Itchy ears, eyes, nose and throat
  • Nasal obstruction secondary to edema
41
Q

How is allergic rhinitis diagnosed?

A
  • Characteristic findings on physical examination including:
    • Boggy, bluish mucous membranes of the nose
    • Dark circles under the lower eyelids (“allergic shiners”)
    • Allergic salute- horizontal crease on the nose that occurs from constant rubbing
    • Rabbit nose- children with allergic rhinitis may exhibit rabbit-like nose wrinkling because of pruritus
  • A smear of nasal secretions will show a high number of eosinophils
42
Q

How is allergic rhinitis treated?

A
  • Avoid triggers
  • Antihistamines
  • Decongestants
  • Cromolyn nasal solution
  • Topical steroids
43
Q

xx

A

Hearing impairment

44
Q

What is the most common cause of hearing impairment in children?

A
  • The most common causes of hearing impairment in children are cerumen impaction and eustachian tube dysfunction
  • Infancy and childhood hearing loss:
    • Congenital causes include asphyxia, erythroblastosis, and maternal rubella
    • Acquired causes include measles, mumps, pertussis, meningitis, influenza and Labyrinthitis
45
Q

xx

A

Mastoiditis

46
Q

What is mastoiditis?

A
  • Inflammation of the mastoid air cells in the temporal bone
47
Q

What causes mastoiditis?

A
  • Mostly seen in children after/with an acute otitis media
  • If resolution does not occur, may lead to acute mastoiditis with periosteitis, acute mastoid osteitis, or chronic mastoiditis
  • Most common pathogen: S. pneumoniae
48
Q

What are the signs and symptoms of mastoiditis?

A
  • Spiking Fever
  • Pain behind the ear (post auricular pain)
  • Erythema and tenderness over the mastoid area
49
Q

How do we diagnose mastoiditis?

A
  • CT is helpful with the diagnosis
50
Q

What is the treatment for mastoiditis?

A
  • Treatment is IV antibiotics -> oral antibiotics and myringotomy (for culture as well as drainage). If ineffective a mastoidectomy is necessary.
51
Q

xx

A

Otitis Externa

52
Q

What is otitis externa?

A
  • Inflammation of the external auditory canal
  • Known as swimmers ear
  • Occurs when trauma introduces bacteria into an area that is excessively wet to dry
53
Q

What causes otitis externa?

A
  • Bacterial: P. aeruginosa, S. aureus, Proteus mirabilis, Klebsiella pneumonia
  • Viral: Herpes
  • Fungal: Candida
54
Q

What are the signs and symptoms of otitis externa?

A
  • Ear pain with movement of the pinna
  • Pruritus of the ear canal
  • Edema of the ear canal
  • Otorrhea: usually white in color
  • Palpable lymph nodes: Peri- and preauricular
  • Normal tympanic membrane
55
Q

How do we diagnose otitis externa?

A
  • Diagnosis is made by otoscopic examination
56
Q

How do we treat otitis externa?

A
  • Topical antibiotics and steroids to reduce edema – aminoglycoside or fluroquinolones +/- corticosteroids (e.g., Cortisporin suspension [hydrocortisone-polymyxin-neomycin-bacitracin])
57
Q

xx

A

TM Perforatation

58
Q

What causes a TM perforation?

A
  • Rupture can occur from infection (acute otitis media) or trauma (i.e., barotrauma, direct impact, or explosion)
59
Q

What are the signs and symptoms of a TM perforation?

A
  • Ear pain
  • Hearing loss
  • Nausea and vomiting
  • Facial weakness
  • Vertigo
  • New onset Otorrhea or clear, particularly unilateral rhinorrhea that is worse with straining
60
Q

How do we treat a TM perforation?

A
  • Most cases will resolve on their own; however, surgical repair of the tympanic membrane as well as the ossicular chain (with persistent hearing loss) may be necessary
  • Water/moisture should be avoided to prevent secondary infection that can impede closure
61
Q

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A

Epistaxis

62
Q

What is an epistaxis?

A
  • Nosebleed
63
Q

What causes an epistaxis?

A
  • The most common location for a nosebleed in children is the anterior septum, because Kiesselbach’s plexus is located there.
  • The most common cause is trauma secondary to a finger nail
64
Q

What are the signs and symptoms of an epistaxis?

A
  • Bleeding may occur from one or both nostrils
65
Q

How do we treat nose bleeds?

A
  • Compression for 10-15 min with head tilted forward
  • Cold compression to the nose
  • Topical vasoconstrictors mat allow visualization of the bleeding site
  • Cauterization using silver nitrite
  • Packing the nose
66
Q

xx

A

Peritonsillar abscess

67
Q

What is a peritonsillar abscess?

A
  • Walled off infection occurring in the space between the superior pharyngeal constrictor muscle and tonsils
  • Results from penetration through the tonsillar capsule and involvement of the neighboring tissue
68
Q

What causes a peritonsillar abscess?

A
  • GABHS

- Anaerobes

69
Q

What are the signs and symptoms of a peritonsillar abscess?

A
  • Preceded by acute tonsillopharyngitis
  • Severe throat pain
  • Trismus- limited opening of the mouth
  • Refusal to swallow or speak
  • “Hot potato voice”
  • Markedly swollen and inflamed tonsils
  • Deviation of soft palate and uvula displaced to opposite side are highly suggestive of tonsillar abscess
70
Q

How do we treat a peritonsillar abscess?

A
  • Aspiration, Incision and drainage

- Antibiotics covering staph and strep. Typically, amoxicillin, clindamycin or ampicillin – sulbactam

End of Rotation: Pediatrics (12 decks)

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