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Pediatrics EOR > EENT > Flashcards

EENT Flashcards

1
Q

Most common bacterial pathogens that cause conjunctivitis

A

h. flu, mcat, strep pneumo

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2
Q

Bacterial pathogen associated with conjunctivitis in contact lens wearers

A

pseudomonas

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3
Q

Most common viral cause of conjunctivitus.

A

adenovirus

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4
Q

Symptoms include redness, discharge, matted eyelids and mild photophobia. PE includes chemosis (edema of conjunctiva), injection of conjunctiva, edema of eyelids

A

conjunctivitis

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5
Q

Topical tx for bacterial conjunctivitis

A

polymyxin B-trimethoprim (Polytrim) drops, sulfacetamide 10% drops, erythromycin ointment

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6
Q

Describe the course and resolution of conjuctivitis related to limiting its spread

A

wash hands. End of bacterial conjunctivitis contagious period is 24 hrs after initiating tx. End of viral conjunctivitis contagious period is 7 days after onset. Children may return to school prior to resolution

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7
Q

Complication of sinusitis that follows bacterial spread into the orbit through the wall of the infected sinus

A

orbital cellulitis

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8
Q

Adverse outcomes related to orbital cellulitis

A

subperiosteal abscess, opthalmoplegia, cavernus sinus thrombosis, vision loss

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9
Q

Manifestations include orbital pain, proptosis, chemosis, limited EOM, diploplia, reduced vision

A

orbital cellulitis

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10
Q

Usually occurs in children <3yrs. No ptosis or opthalmoplegia. Associated w/skin lesion or trauma. Caused by s. aureus or group A strep

A

periorbital cellulitus (anterior to palpebral fascia)

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11
Q

Diagnostic method of choice for orbital cellulitis

A

CT scan (determines extent and need for surgical drainage)

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12
Q

Treatment for orbital cellulitis

A

parenteral vanco plus one of the following: ceftriaxone (Rocephin), cefotaxime (Clarofan), ampicillin-sulbactam (Unasyn), pipercillin-tazobactam (Zosyn)

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13
Q

often is used as an initial screen for strabismus. involves shining a light onto the eyes from a distance and observing the reflection of the light on the cornea with respect to the pupil. The location of the reflection from both eyes should appear symmetric

A

corneal light reflex

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14
Q

child is asked to visually fix on a target at distance or near. The examiner covers one eye while observing the opposite eye for movement. No movement is detected if the child has normal ocular alignment. Manifest strabismus (tropia) is present if the eye that is not occluded shifts to refixate on the target when the fellow, previously fixating eye, is covered.

A

cover test

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15
Q

a functional reduction in the visual acuity of an eye caused by disuse or misuse during the critical period of visual development

A

amblyopia

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16
Q

Deviations of the eye toward the nose, which are the most common type of strabismus in children

A

esodeviations

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17
Q

most common cause of esotropia in children. the physiologic convergence cannot be overcome by fusional divergence. occurs more commonly in children who have hyperopia (farsightedness)

A

Accommodative esotropia

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18
Q

treatment of accomodative esotopria

A

cycloplegic refraction and prescription of hyperopic spectacles

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19
Q

defined by moderate to severe bulging of the tympanic membrane (TM) or new onset of otorrhea accompanied by acute signs of illness and middle ear inflammation

A

acute otitis media

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20
Q

most frequent diagnosis in sick children visiting clinicians’ offices and the most common reason for administration of antibiotics

A

acute otitis media

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21
Q

decreased the incidence of AOM

A

Introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2000 and the 13-valent pneumococcal conjugate vaccine in 2010

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22
Q

Peak age of attacks for otitis media

A

6-18 mos

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23
Q

How does the presence of viruses effect otitis media?

A

increase middle ear inflammation, decrease neutrophil fxn, and reduce antibiotic penetration into the middle ear

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24
Q

Which three species account for most of the bacterial isolates from middle ear fluid?

A

Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis

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25
Q

Present with ear pain, otorrhea, fever, irritability, headache, apathy, anorexia, vomiting, and diarrhea

A

otitis media

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26
Q

Not recommended for treatment of AOM due to lack of benefit and a potential for delayed resolution of middle ear fluid

A

antihistamines and decongestants

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27
Q

first-line therapy for children with AOM who are treated with antibiotics

A

amoxicillin

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28
Q

alternatives for children with AOM who have had immediate hypersensitivity reactions (anaphylaxis, angioedema, bronchospasm, urticaria) to penicillin

A

Macrolides (azithromycin, clarithromycin, erythromycin)

29
Q

Appropriate fu for children with AOM

A

fail to improve after 48 to 72 hours of antibiotic therapy should be seen again. <2 years be seen 8 to 12 weeks after diagnosis. >2yrs seen if there are concerns regarding persistent hearing loss

30
Q

NOT an indication of treatment failure or an indication for additional antibiotic therapy in AOM

A

Persistent middle ear effusion after the resolution of acute symptoms

31
Q

presents with paroxysms of sneezing, rhinorrhea, nasal obstruction, and nasal itching. Postnasal drip, cough, irritability, and fatigue are other common symptoms

A

allergic rhinitis

32
Q

Accentuated lines or folds below the lower lids which suggests concomitant allergic conjunctivitis

A

Dennie-Morgan lines

33
Q

most effective treatment and should be first-line therapy for mild to moderate disease of allergic rhinitis

A

Intranasal corticosteroids

34
Q

With the exception of cetirizine (Zyrtec), less likely to cause sedation and impair performance

A

second-generation antihistamines (allegra, claritin)

35
Q

Which two intranasal glucocorticoids can be initiated as early as 2 yrs?

A

Fluticasone furoate (Veramyst) and Mometasone (Nasonex)

36
Q

Which two intranasal glucocorticoids cannot be used to treat allergic rhinitis before 12 yrs of age?

A

Fluticasone propionate (Flonase) and Triamcinolone (Nasacort)

37
Q

When can most of the second generation oral antihistamines be used safely in children and which two cannot be used until 2 yrs and 12yrs respectively?

A

six months (Cetirizine (Zyrtec), Desloratadine (Clarinex), Fexofenadine (Allegra).

2 yrs for Loratadine (Claritin) and 12 yrs for Levocetirizine (Xyzal)

38
Q

What age can oral decongestant (pseudoephedrine) be used?

A

12 yrs

39
Q

Name the intranasal anticholinergic that can be initiated at 6 yrs for allergic rhinitis

A

Ipratropium (Atrovent)

40
Q

Name the Leukotriene receptor antagonist that can be initiated at 6 months for allergic rhinitis

A

Montelukast (Singulair)

41
Q

act by decreasing the influx of inflammatory cells and inhibiting the release of cytokines, thereby reducing inflammation of the nasal mucosa

A

intranasal glucocorticoids

42
Q

What symptom do second generation antihistamines have little effect on?

*good at relieving histamine mediated sx: sneezing, itching, rhinorrhea, ocular sx

A

nasal congestion

43
Q

Why is duration of intranasal decongestants limited to 3-5 days?

A

potential for developing rhinitis medicamentosa or have rebound or recurring congestion

44
Q

Risk factors for the development of mastoiditis?

A

<2 yrs and recurrent AOM

45
Q

Postauricular tenderness, erythema, swelling (with loss of the postauricular crease), fluctuance (or draining fistula), or mass

A

mastoiditis

46
Q

Cornerstone of management of mastoiditis

A

referral to ENT. IV abx and myringotomy with or without placement of a tympanostomy tube

47
Q

Manifestations include pruritus, pain, and erythema, but as the disease progresses, other problems such as edema, otorrhea, and conductive hearing loss may develop

A

otitis externa

48
Q

most common pathogenic organisms responsible for external otitis

A

P. aeruginosa (38 percent), S. epidermidis (9 percent), and S. aureus (8 percent)

49
Q

Physical exam findings indicative of external otitis

A

Tenderness with tragal pressure or when the auricle is manipulated or pulled

50
Q

First step in treatment of otitis externa

A

Cleaning out the external canal (aural toilet) with wire loop or cotton swab.

51
Q

most important concern with topical aminoglycoside agents, including neomycin,tobramycin, and gentamicin used to treat otitis externa

A

ototoxicity

52
Q

First line treatment for moderate otitis externa

A

Cipro HC (cipro + hydrocrotisone) or Cortisporin (polymyxin B-neomycin-hydrocortisone) otic suspensions. Referral to ENT if perforated TM

53
Q

Manifestations include ear pain, conductive hearing loss, otorrhea

A

TM perforation

54
Q

Management of TM perforation with minimal hearing loss (decreased perception of whisper, minor asymmetry or <40 dB on formal audiometry)

A

Water precautions (keeping water out of the ear), Antibiotic ear drops (eg, ofloxacin otic drops) for contaminated wounds, reexamination by the primary care provider in four weeks with audiometry

55
Q

presents as irregular white plaques with or without an erythematous base on the buccal or lingual mucosal surface of the mouth

A

oral candidiasis (thrush)

56
Q

usually the initial agent to treat oral candidiasis (thrush), as it is not absorbed systemically from the gastrointestinal tract

A

nystatin. dose of 0.5 mL to each side of the mouth, given four times a day

57
Q

used when the candidal infection is recalcitrant to topical therapy

A

oral fluconazole (3 mg/kg, once a day for seven days)

58
Q

the source of the majority of nosebleeds

A

Kiesselbach’s plexus

59
Q

First step in acute mgmt of active nosebleed

A

direct compression for 5-10 mins

60
Q

Preferred nasal decongestant for nosebleeds in children that don’t respond to direct compression

A

oxymetazoline (claritan)

61
Q

should be avoided in the treatment of infants younger than one year of age with epistaxis because of the risk of aspiration

A

nasal packing

62
Q

should be avoided in infants younger than one year of age because of the risk of aspiration

A

humidification of the nasal mucosa (humidifier or saline spray) and prevention of local trauma (avoid nose picking)

63
Q

Medication that should be discontinued in patient with h/o allergic rhinitis who presents with epistaxis

A

nasal corticosteroids

64
Q

most common cause of bacterial pharyngitis in children and adolescents

A

group A strep

65
Q

In children older than three years, fever, headache, abdominal pain, nausea, and vomiting with sore throat, may include exudative pharyngitis, enlarged tender anterior cervical lymph nodes, palatal petechiae, an inflamed uvula, and scarlatiniform rash

A

group a strep pharyngitis

66
Q

characterized by fever, severe pharyngitis, and anterior and posterior cervical or diffuse lymphadenopathy. Prominent constitutional symptoms include fatigue, anorexia, and weight loss. The illness is protracted with pharyngitis lasting longer than usual in patients with pharyngitis caused by other pathogens

A

mononucleosis pharyngitis

67
Q

Adverse effects of penicillin (amoxicillin/ampicillin) administration with EBV infection

A

development of rash

68
Q

characterized by high fever, cough, headache, and myalgias that occur in seasonal epidemics

A

influenza

69
Q

Why is GAS pharyngitis uncommon in children less than 3 yrs old?

A

they have fewer epithelial cell attachment sites in the throat

Pediatrics EOR (3 decks)

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