EENT for a child Flashcards
The clinical signs of conjunctivitis are similar across all ages and regardless of the cause. What are the 4 main signs of Conjunctivitis?
-Redness
-Swelling of the conjunctiva
-Eyelid edema
-Discharge
In children, the causes of conjunctiva are usually due to what 4 causes?
-Viral
-Bacterial
-Allergies
-Foreign body
What type of infection accounts for MOST cases of conjunctivitis in children?
Bacterial infection
There are 4 types of Conjunctivitis r/t the 4 causes: Viral, Bacterial, Allergy. Foreign body. What are the clinical manifestations of Bacterial Conjunctivitis?
What is bacterial conjunctivitis casually called?
Bacterial conjunctivitis is called “Pink eye”
-Purulent drainage (TM)
-Crusted eyelids
-Inflamed conjunctiva and swollen eyelids (On all types of infection)
There are 4 types of Conjunctivitis r/t the 4 causes: Viral, Bacterial, Allergy. Foreign body. What are the clinical manifestations of Viral Conjunctivitis?
-Serous (watery) drainage
-Usually secondary to upper respiratory tract infection (otitis media, Rhinitis, Pharyngitis, etc.)
There are 4 types of Conjunctivitis r/t the 4 causes: Viral, Bacterial, Allergy. Foreign body. What are the clinical manifestations of Allergic Conjunctivitis?
-Itching of the eyes
-Watery to thick, stringy discharge
There are 4 types of Conjunctivitis r/t the 4 causes: Viral, Bacterial, Allergy. Foreign body. What are the clinical manifestations of Foreign body Conjunctivitis?
-Tearing
-Pain
-Usually only one eye is affected
In the tx of Conjunctivitis, the protocol of whipping away accumulated secretions is by wiping from where to where?
From the inner canthus down and out, away from the opposite eye
Down and Out
What is used to remove the crust off of an inflamed conjunctiva?
A warm, moist compress, like a washcloth, wrung out with hot tap water
Warm, moist compresses are NOT kept on the eye with conjunctivitis. Why?
Covering the eye promotes bacterial growth
The treatment for viral conjunctivitis is what?
Viral conjunctivitis is self-limiting and goes away on its own. Just remove the crust accumulated on the affected eye.
What treatment method is used for bacterial conjunctivitis?
Topical antibiotics like Polymyxin or Polysporin, or systemic antibiotics if needed.
For children 1 year and older, what antibiotic drug classes are used to treat bacterial conjunctivitis?
Fluoroquinolones and aminoglycosides
What treatment method is used for Allergy conjunctivitis?
Allergy meds like antihistamines
Eyedrops for conjunctivitis are used during the (____) and topical ointment used during the (____). The topical ointment is given at (____) because the ointment stays in the eye (____) but (_____) vision.
Eyedrops for conjunctivitis are used during the (day) and topical ointment used during the (night). The topical ointment is given at (night) because the ointment stays in the eye (longer) but (blurs) vision.
Are corticosteroids a good method of treatment for the inflammation caused by conjunctivitis?
No, because they reduce ocular resistance to bacteria
What is Strabismus?
“Lazy-eye”
One eye deviate from the point of fixation due to a weakened ocular muscle
What are 3 s/s of Strabismus?
-Diplopia (Double vision)
-Noticeable eye deviation (you can see the lazy eye)
-Head tilting to see
What is the dx test commonly used for testing Strabismus?
The Corneal Light Reflex test
aka
Hirschberg test
How is a Corneal Light Reflex test performed?
A penlight or light from an ophthalmoscope, is shined into a child’s eye from 16 inches away. If the eyes are orthophoric (normal), the light will be symmetrical in each pupil. If the light is off center in one eye, the eyes are misaligned
How is a cover test performed to test for Strabismus?
Cover one eye and have the child read something close (13-inches) or far (20 ft) and then take your hand off the covered eye. If the eye that was NOT covered moves away from the target, the child has Strabismus
How do you treat Strabismus in children with an eye patch?
Cover the unaffected eye so that the lazy eye can focus and become stronger
If Strabismus is not corrected in children between the ages of (-), Amblyopia will occur. What is Amblyopia?
If Strabismus is not corrected in children between the ages of (4-6), Amblyopia will occur.
Amblyopia is blindness in one eye. The brain recognizes that the eye doesn’t work, and so it shuts it off
In simple terms, Cataracts is “(___ _________)”. This means a partial or total (_____) of the lens
In simple terms, Cataracts is “(Lens cloudiness)”. This means a partial or total (opacity) of the lens
What are the normal signs and symptoms associated with cataracts? (Besides the opacity)
-Blurred vision
-Annoying glare
-Pupils change from black, to grey, to milky white
While cataract patients have a red reflux?
Nope
Cataract patients may also suffer from Nystagmus. What is Nystagmus?
Rapid darting/movement of the eyes
What are the most common assessment findings for the causation of cataracts?
-Congenital
-Trauma
-Aging process
-DM
What is the only treatment method for cataracts?
Intracapsular surgery to remove the lens and capsule and implant a new lens. Place ocular dressing over the affected eye to strengthen the weaker eye.
What is glaucoma?
An increase in intraocular pressure caused by an obstruction of outflow of aqueous humor
What are the s/s of Glaucoma?
-Cloudy, blurry vision
-Peripheral vision loss
-Halo’s around objects and people
-Intraocular pressure read on “Tonometer” between 10-21mmHG
Buphthalmos is a symptom of Glaucoma. What is Buphthalmos?
Enlargement of the eyeball; Bug-eyed
The red reflex in a pt with Glaucoma will be what color?
Grey to green
How do you treat Glaucoma?
Open-angle glaucoma is treated with medications like beta-blockers (Timolol) to break up the Aqueous humor meshwork
Closed-Angle glaucoma is treated with surgery, like trabeculoplasty
If Glaucoma begins before a child is 3-years old, what does this mean for the glaucoma?
It means that the glaucoma is congenital/Infantile
Premature babies that are exposed to frequent/consistent high levels of O2 are at risk for developing what ocular disease?
Retinopathy of immaturity
High concentrations of O2 in a premature infant cause vaso(______) of the immature (_______) vessels.
High concentrations of O2 in a premature infant cause vaso(constriction) of the immature (retinal) vessels.
When the retinal vessels are constricted (due to high levels of O2), how does the babies brain handle this? What occurs because of this response?
When the retinal vessels are constricted (due to high levels of O2), the brain makes multiple branching blood vessels in the eyes to compensate, leading to retinal detachment (blindness)
Risk factors for Retinopathy of Prematurity include a gestational age of less than (_______), a birthweight of less than (__)lbs, or (____) grams, and an O2% between (__-___)% for longer than (__-__) hours
Risk factors for Retinopathy of Prematurity include a gestational age of less than (36-weeks), a birthweight of less than (4.4)lbs, or (2000) grams, and an O2% between (94-100)% for longer than (48-72) hours
How is Retinopathy of Prematurity diagnosed?
By an Ophthalmologic exam, which will notice excess blood vessels in the eye
2 Tx options for Retinopathy of Prematurity are the use of Vitamin (_) and Laser (________________)
2 Tx options for Retinopathy of Prematurity are the use of Vitamin (E) and Laser (Photocoagulation)
Vitamin (_) helps Retinopathy how?
Laser (________________) helps retinopathy how?
Vitamin (E) helps with the tissue response to excess O2
Laser (Photocoagulation) destroys excess blood vessels
There are 2 types of Otitis Media: Acute Otitis Media, and Otitis Media with Effusion.
What is Acute Otitis Media?
Acute Otitis Media is an Inflammation of the middle ear resulting from a bacterial or viral infection that causes a sudden onset of symptoms
There are 2 types of Otitis Media: Acute Otitis Media, and Otitis Media with Effusion.
What is Otitis Media with Effusion?
Otitis Media with Effusion is when fluid enters the middle ear. No signs of infection
What is the most common bacterial cause of Acute OM?
Bacterial infection of Streptococcus Pneumoniae
What are the most common causes of viral Acute OM?
RSV and influenza
Most episodes of AOM occur during the 1st (_________) of life, but the incidence of AOM decreases over time, until the ages of (-) when it picks back up due to the children entering (_______)
Most episodes of AOM occur during the 1st (24-months) of life, but the incidence of AOM decreases over time, until the ages of (5-6) when it picks back up due to the children entering (school)
Living in a household with what increases the risk of AOM?
Passive smoke
Passive (_______) increases persistent Otitis Media with Effusion due to it enhancing the (attachment) of bacteria in the ear, thus blocking (________) from the (____________) tubes (ear tubes).
Passive (smoking) increases persistent Otitis Media with Effusion due to it enhancing the (attachment) of bacteria, thus blocking (drainage) from the (Eustachian) tubes (ear tubes).
Children are more susceptible to chronic otitis media because of their short what?
Eustachian Tubes
What are signature signs of otitis media in a child?
-head-rolling
-Tugging on the ear and crying
-Red bulging tympanic membrane
-Deafness/Ringing in the ears
-Drainage
What age will you see ear tugging in patients infected with otitis media?
5-6 years old
Most doctors want you to wait how many days to see if the OM clears up on its own?
7-10 days
What pain meds are usually given to children to handle the pain of OM?
Tylenol
How should you position a child with AOM and a fever?
Side-lying on the side of the affected ear
Bedrest for fever
In patients with severe pain caused by AOM, a surgical procedure known as a Myringotomy may be necessary. What is a Myringotomy?
Myringotomy is a surgical incision in the eardrum and insertion of a ventilatory tube to allow infected inner ear fluid to drain out
What is the method for assessing the tympanic membrane in a child under 3 years of age?
Pull the ear “down and back”
Most AOM infections are (____), but if they are (_______), use an oral (__), such as (__________)
Most AOM infections are (Viral), but if they are (bacterial), use an oral (ABx), such as (Amoxicillin)
A complication of OM is a Cholesteatoma. What is a Cholesteatoma?
A Cholesteatoma is a clump of scar tissue scales growing on the eardrum
What is the most frequent complication associated with OM?
Residual deafness
Mastoiditis and Meningitis are another 2 possible complications of OM.
What is Mastoiditis and how is it different from Meningitis?
Mastoiditis is an inflammation of the mastoid bone, while Meningitis is an infection of the meninges, which is the protective covering of the brain and spinal cord
What are 5 complications of OM?
-Residual Deafness
-Meningitis
-Mastoiditis
-Chronic OM
-Cholesteatoma
What is Otitis Externa better known as?
“Swimmers’ ear”
What are 4 s/s of Mastoiditis? (Besides an inflammation of the Mastoid bone)
-Stiff neck
-Facial paralysis
-Vomiting
-Auricle (Ear) discharge
Inflammation in Otitis Externa mainly due to what 3 factors?
-Swimming (Hence swimmers’ ear)
-Increased Humidity
-Infection due to Staphylococcus Aureus
The predominant symptom of OE is ear (____) that is accentuated by manipulation of what 2 things?
The predominant symptom of OE is ear (pain) that is accentuated by manipulation of the pinna (top of the ear) with extra pressure on the tragus
As an OE infection progresses, you will see an edema, erythema, and a discharge with what color/consistency?
Cheesy green-blue-grey discharge
To avoid OE, time in the water should be limited to what?
Under an hour
After exiting the water, to avoid OE, you should make sure your ears are completely (___), and not re-enter the water for (-) hours.
After exiting the water, to avoid OE, you should make sure your ears are completely (dry), and not re-enter the water for (1-2) hours.
To restore (__) and prevent further infection of OE, what is the procedure to be taken? (excluding ABx ear drops)
To restore (pH) and prevent further infection of OE:
-Put a 50:50 combination of acetic acid (White vinegar) and rubbing ETOH in both ear canals when rising, going to bed, and at the end of each swim
For the 50:50 mixture of (________), aka (____________) and rubbing (____), how long should it stay in the ear canal?
How long before a child can submerge their head after taking the mixture?
For the 50:50 mixture of (acetic acid), aka (White vinegar) and rubbing (ETOH), it should stay in the ear canal for up to 5 minutes, and the child should wait 7-10 days before submerging their head again.
Can a child with Tympanostomy tubes safely take the 50:50 mixture for the prophylaxis of OE?
No, a child with Tympanostomy tubes should NOT take this mixture
When the inflammation of the adenoids or palatine tonsils occurs, what happens to a child?
Their airway becomes blocked
When to tonsils cause an emergency situation?
When the tonsils touch (kissing tonsils)
What are 5 s/s of Tonsilitis/Adenoiditis?
-Dry throat/mouth
-Bad breath
-Nasally and muffled voice
-Persistent cough
-Impaired sense of taste and smell
Because of the proximity of the adenoids to the eustachian tubes, adenoiditis can lead to what ear disease? How
OM; Otitis Media
Inflammation of the adenoids blocks drainage from leaving the eustachian tubes, causing OM
What is the tx of Tonsilitis in an emergency situation (kissing tonsils)?
Tonsillectomy
The number 1 thing to look out for in a child with their tonsils is sings of (______), because the tonsils are very (______).
The number 1 thing to look out for in a child with their tonsils is sings of (bleeding/hemorrhaging), because the tonsils are very (vascular).
What are some s/s’s of a hemorrhaging tonsil?
-Constant swallowing
-Red emesis
-Tachycardia
-Anxiousness/Restlessness
-Pallor
-Constantly clearing throat
What should you avoid giving a child so that you can clearly see bright red emesis?
Red dyes
Can you treat Tonsillitis and Adenoiditis with an ABx?
Yes
After a Tonsillectomy or Adenoidectomy, when should you elevate the child’s HOB?
Elevate once the child is awake
After a Tonsillectomy or Adenoidectomy, what is a child discouraged from doing that could aggravate the operative site?
-Coughing frequently
-Clearing the throat
-Blowing their nose
After a Tonsillectomy or Adenoidectomy, most children feel moderate (____) and need (____________) at regular intervals for how long?
After a Tonsillectomy or Adenoidectomy, most children feel moderate (pain) and need (pain meds) at regular intervals for the first 24-48 hours
What type of local anesthetics can be given to a child post Tonsillectomy/Adenoidectomy?
Tetracaine lollipops or ice pops
It is normal to have a (____) in their vomit, post-surgery, with dark (____) blood in the emesis, the nose, and between the (____). It can take (__) days to recover from the surgery
It is normal to have a (clot) in their vomit, post-surgery, with dark (brown) blood in the emesis, the nose, and between the (teeth). It can take (14) days to recover from the surgery
