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Pediatrics EORE > ENOT/Ophthalmology > Flashcards

ENOT/Ophthalmology Flashcards

1
Q

What are the most common pathogens causing otitis externa?

A

Psuedomonas and Enterobacteria

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2
Q

What is required to make the clinical diagnosis of otitis media?

A
  • Bulging tympanic membrane on exam
  • Signs of acute inflammation (marked erythema of the TM, fever, or ear pain)
  • Middle ear effusion
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3
Q

What are the most common etiologies of acute otitis media?

A

S. pneumonia, H. Influenza (more common to cause bilateral OM), chlamydia (< 6 months)

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4
Q

What defines chronic otits media?

A

Clear serous fluid in the middle ear without s/sx of ear infection (may have hearing loss / asymptomatic) – no abx

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5
Q

What is the treatment for acute otitis media (AOM)?

What are some complications associated with AOM?

A

High dose amoxicillin or Augmentin or cephalosporin (penicillin-allergic) <6 mos and 6 mos or greater in children with high fever, bilateral disease, and severe pain.

6 mos or greater with none of the three symptoms can get analgesia and observation

Mastoiditis and bullous myringitis

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6
Q

What is the treatment for recurrent otitis media?

A

tympanostomy, tympanocentesis, or myringotomy

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7
Q

What are the indications for tympanostomy tubes?

What are other names for ear tubes?

A
  • > 3 episodes of OM in the past 6 months
  • > 4 episodes of OM in the past 12 months

Tympanostomy, myringtomy

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8
Q

Are most causes of pharyngitis viral or bacterial?

A

Viral, adenovirus is the most common cause

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9
Q

What is the most common cause of fungal pharyngitis?

A

Inhaled steroid use

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10
Q

What is the presentation of mononucleosis?

What is the name of the viral test for mono?

A
  • Fever
  • Sore throat
  • Lymphadenopathy
  • Splenomegaly

Heterophile agglutination test (monospot)

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11
Q

What is the Centor Score?

A

Used to diagnose strep pharyngitis

Centor Score
1. Absence of a cough
2. Exudates
3. Fever (> 100.4 F)
4. Cervical lymphadenopathy

If 3/4 criteria are met get a rapid strep test

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12
Q

What type of lymphadenopathy is present in strep pharyngitis?

A

Cervical Lymphadenopathy

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13
Q

What symptoms are not suggestive of strep pharyngitis?

A
  • Coryza
  • Hoarseness
  • Cough
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14
Q

What is the first line treatment for group A strep?

What are complications associated with strep?

A

Penicillin

Azithromycin if penicillin-allergic

Rheumatic fever and post strep glomerulonephritis

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15
Q

What is the treatment for mononucleosis?

A

Symptomatic and avoid contact sports; antibiotics such as amoxicillin or ampicillin may cause a rash

For strenuous contact sports patients should stay out for four weeks after illness onset

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16
Q

A 6 year old boy presents to the clinic with clear nasal discharge for 2 days. This has also been associated with sneezing. On nasal exam, the mucosa and turbinates appear edematous and slightly bluish. He has swollen dark circles under his eyes and transverse nasal crease. What is the most likely diagnosis?

A

Allergic Rhinitis

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17
Q

What are the treatment options for allergic rhinitis?

A
  • Antihistamines
  • Cromolyn
  • Nasal or systemic corticosteroids
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18
Q

Intranasal decongestants (Afran) should not be used be for more than 3-5 days due to what adverse effect?

A

Rhinitis medicamentosa

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19
Q

What is the presentation of viral conjunctivitis?

What is the most common etiology?

A

Copious watery discharge, scant mucoid discharge

Adenovirus

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20
Q

A 4 year old girl presents with purulent yellow discharge around her eyes. You notice crusting. Her mother says she wakes up with discharge in her eyes and it improves throughout the day. What is the most likely diagnosis?

A

Bacterial conjunctivitis

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21
Q

What are the etiologies of bacterial conjunctivitis?

A
  • S. pneumonia
  • S. aureus
  • M. catarrhalis
  • Gonococcal
  • Chlamydia
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22
Q

What type of conjunctivitis is typically bilateral?

A

Allergic conjunctivitis

Will present with red eyes, itching and tearing, cobblestone mucosa on the inner/upper eyelid

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23
Q

What is the preferred treatment for bacterial conjunctivitis?

A
  • Gentamicin/tobramycin (Tobrex)

Erythromycin or Polymin B

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24
Q

Contact lens users are at a higher risk for conjunctivits caused by what pathogen?

What is the treatment?

A

Pseudomonas

Fluorquinolone (ciprofloxacin)

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25
Q

What form of conjunctivitis requires prompt referal to opthalmology?

A

Neisseria conjunctivits, also give topical and systemic antibiotics

26
Q

What are the 3 D’s of epiglotitis?

A
  • Dysphagia
  • Drooling
  • Respiratory Distress
27
Q

What virus causes supraglottic inflammation and obstruction of the airway?

A

Haemophilus influenza type B (Hib)

28
Q

What classic finding is seen on x-ray with epiglotitis?

A

Thumbprint sign on lateral neck film from the swelling

29
Q

In a Weber Test sound will lateralize to what ear in conductive hearing loss?

A

The affected ear

30
Q

What is the most common cause of conductive hearing loss?

A

Otitis Media and Cerumen Impactation

31
Q

A 2 year old arrives at the ED with a swollen and erythematous eyelid, proptosis, pain with movement of the eye, and an inability to adduct or abduct his eye. What is the most likely diagnosis?

What is the treatment?

A

Orbital Cellulitis

Hospitalization and IV abx (vanco)

32
Q

What is seen on otoscopy exam in otitis externa?

A

Edema with cheesy white discharge, palpation of the tragus is painful

33
Q

What is the treatment for otitis externa?

A

Ciprofloxacin and dexamethasone drops for 7 days

34
Q

What is exotropia?

A

Outward turning of the eyes

35
Q

What is esotropia?

A

In turning of eyes

36
Q

What results if strabismus isn’t treated before age 2?

A

Amblyopia (lazy eye)

37
Q

A 6-year-old boy is brought into the emergency department for two days of neck pain, severe sore throat, and fever after recovering from a recent cold. Upon physical exam, the patient has a fever of 102°F and has decreased range of motion of the neck. He also has bilateral cervical lymphadenopathy, has difficulty opening his mouth, and refuses to swallow. A lateral neck X-ray shows some soft tissue swelling anterior to the cervical vertebrae from C2–C4. Which of the following is the most likely diagnosis?

A) Angioedema
B) Foreign body aspiration
C) Peritonsillar abscess
D) Retropharyngeal abscess

A

Retropharyngeal abscess

A peritonsillar abscess would present with a muffled voice. If left untreated it can progress to the retropharyngeal space and swelling will be seen on x-ray at the level of C2-C4

38
Q

A 2-year-old boy presents to the hematology clinic with easy bruising and recurrent hemarthrosis. He has severe hemophilia A. Which of the following is the best treatment?

A) Desmopressin
B) Factor IX replacement
C) Factor VIII replacement
D) Platelet transfusions

A

Factor VIII replacement

39
Q

A 6-year-old boy presents with a 2-day history of sore throat and fever. His examination reveals tonsillar exudates and tender anterior cervical lymphadenopathy. His mother reports that he has no cough. A rapid strep test is positive. Considering his age and symptoms, which of the following is the most appropriate management?

What if the patient had a previous reaction to a penacillin?

A

Prescribe amoxacillin and supportive care

Given the positive rapid strep test and typical symptoms of streptococcal pharyngitis, appropriate management includes antibiotic therapy with amoxicillin.

Azithromycin

40
Q

A 3-year-old girl is brought in with a 24-hour history of irritability and pulling at her right ear. On otoscopic exam, you note a red, bulging tympanic membrane. Which additional symptom would most support the diagnosis of acute otitis media?

A

Fever

41
Q

A 10-year-old patient presents with nasal congestion and a clear nasal discharge for the past three weeks. He also has a frequent cough, especially at night. What is the most likely diagnosis?

A

Allergic Rhinitis

42
Q

An 8-year-old girl complains of a sore throat, fever, and difficulty swallowing. Her parents mention a recent history of pharyngitis in her sibling. Examination reveals enlarged tonsils with white patches. The most appropriate next step in management is to:

A. Start IV antibiotics
B. Obtain a throat culture
C. Administer intramuscular steroids
D. Schedule for tonsillectomy

A

Obtain a throat culture

Throat culture is needed in order to confirm diagnosis of strep throat before starting antibiotics.

43
Q

A pediatric patient with a known diagnosis of Down syndrome presents with snoring and episodes of observed apneas during sleep. What is the most likely cause of these symptoms?

A

Obstructive Sleep Apnea (OSA)

In children, particularly those with Down syndrome, symptoms like snoring and observed apneas are indicative of obstructive sleep apnea, often related to adenotonsillar hypertrophy

44
Q

A 4-year-old boy presents with a history of three episodes of acute otitis media in the past 6 months. His mother inquires about prevention strategies. Which of the following would be an appropriate recommendation?

A

Myringotomy with tube insertion

For a child with recurrent acute otitis media, myringotomy with tympanostomy tube insertion is an effective preventative measure to reduce the frequency and severity of future episodes.

45
Q

A 7-year-old girl presents with bilateral itchy eyes, sneezing, and a clear nasal discharge which worsens during the spring. Skin testing confirms allergies to pollen. Which of the following would be the most appropriate management?

A. Oral antihistamines
B. Daily nasal saline irrigation
C. Start a leukotriene receptor antagonist
D. Systemic corticosteroids

A

Oral antihistamines

46
Q

During a well-child visit, a parent expresses concern about their child’s repeated episodes of strep throat over the last year. They ask about the benefits of tonsillectomy. Which of the following is an indication for considering tonsillectomy in this scenario?

A. More than seven episodes in the past year
B. Three episodes over the past three years
C. Five episodes, with one occurring in the previous year
D. Episodes only occurring during winter months

A

More than seven episodes in the past year

Indications for tonsillectomy include recurrent severe infections defined as seven or more episodes of strep throat in the previous year, making this choice valid based on the parent’s concerns.

47
Q

A 2-year-old boy is brought to the clinic by his parents who report that he has been tugging at his left ear and crying more than usual. The child also has a low-grade fever. Otoscopic examination shows a dull, opaque tympanic membrane with limited mobility. What is the most likely diagnosis?

A. Otitis externa
B. Otitis media with effusion
C. Acute otitis media
D. Eustachian tube dysfunction

A

Acute otitis media

48
Q

An 11-year-old boy with a peanut allergy suddenly develops hoarseness, difficulty breathing, and swollen lips after eating a snack at a party. The most immediate action should be:

A

Administer epinephrine

49
Q

A 5-year-old girl presents with redness, itching, and discharge in both eyes for two days. The mother notes that several classmates have similar symptoms. The most likely diagnosis is:

A

Viral Conjunctivitis

Given the outbreak among classmates and the symptoms of redness, itching, and discharge, viral conjunctivitis is the most likely diagnosis

50
Q

A 7-year-old boy complains of sudden onset of pain, redness, and decreased vision in his left eye after playing in the park. On examination, you observe a small foreign body on the cornea. What is the most appropriate initial step in management?

A. Immediate referral to an ophthalmologist
B. Attempt removal with a moist cotton swab
C. Prescribe antibiotic eye drops and reassess in 24 hours
D. Flush the eye with saline solution and reassess

A

Immediate referral to an ophthalmologist

The presence of a foreign body on the cornea, especially with pain and decreased vision, warrants immediate referral to an ophthalmologist for proper removal and management to prevent further injury.

51
Q

An 8-year-old presents with bilateral eyelid swelling and a bluish discoloration around the eyes. The child reports mild pain but no vision changes. The most likely cause of these findings is:

A. Periorbital cellulitis
B. Allergic reaction
C. Trauma
D. Sinusitis

A

Sinusitis

Bilateral eyelid swelling and bluish discoloration around the eyes, commonly known as “allergic shiners,” are often associated with sinusitis in children.

52
Q

During a routine exam, you notice a white reflex in the right eye of a 3-year-old child. The child has not had any vision or behavioral complaints. What is the most appropriate next step?

A. Reassure the parent that this is a normal finding
B. Refer to a pediatric ophthalmologist for further evaluation
C. Prescribe glasses and schedule a follow-up in six months
D. Monitor the reflex and reevaluate in one year

A

Refer to a pediatric ophthalmologist for further evaluation

A white reflex in the eye, known as leukocoria, could be a sign of serious conditions like retinoblastoma or cataract and requires prompt evaluation by a pediatric ophthalmologist

53
Q

A 12-year-old patient presents complaining of intermittent double vision for the past week. She has a history of sinusitis. On examination, you notice horizontal diplopia that worsens with looking to the left. Which of the following is the most likely diagnosis?

A. Conjunctivitis
B. Sixth nerve palsy
C. Astigmatism
D. Corneal abrasion

A

Sixth nerve palsy

Horizontal diplopia that worsens with looking to one side is characteristic of sixth nerve palsy, which can be related to increased intracranial pressure or a post-viral effect, sometimes associated with sinusitis.

54
Q

A 4-year-old boy is brought in by his parents who report that the child has been frequently rubbing his eyes and complaining of headaches, especially after watching TV. On examination, the child squints while looking at distant objects. What is the most likely diagnosis?

A. Digital eye strain
B. Myopia
C. Hyperopia
D. Presbyopia

A

Myopia

Frequent eye rubbing, headaches, and squinting while looking at distant objects are classic signs of myopia (nearsightedness) in children

55
Q

A 7-year-old girl presents with fever, painful eye movement, eyelid swelling, and redness. The mother reports that her daughter had a “cold” last week. On examination, you note proptosis and restricted ocular motility. What is the most likely diagnosis?

A. Periorbital cellulitis
B. Orbital cellulitis
C. Conjunctivitis
D. Acute glaucoma

A

Orbital cellulitis

The symptoms of fever, painful eye movement, eyelid swelling, redness, proptosis, and restricted ocular motility are characteristic of orbital cellulitis.

56
Q

A 9-year-old boy presents with eyelid swelling, tenderness to palpation around the eye, and mild fever. There is no pain on eye movement, and visual acuity is normal. The most appropriate management for this condition would be:

A. Immediate surgical intervention
B. Oral antibiotics and close follow-up
C. Topical antibiotic eye drops
D. CT scan of the orbit

A

Oral antibiotics and close follow-up

For periorbital cellulitis with no pain on eye movement and normal visual acuity, treatment with oral antibiotics and close monitoring is appropriate.

57
Q

Which of the following is an important distinguishing feature between periorbital and orbital cellulitis?

A. Presence of fever
B. Painful eye movements
C. Redness of the eyelid
D. Response to topical antibiotics

A

Painful eye movements

Painful eye movements are typical of orbital cellulitis and help distinguish it from periorbital cellulitis.

58
Q

Which of the following factors increases the risk for developing orbital cellulitis in children?

A. Use of contact lenses
B. Recent upper respiratory tract infection
C. Allergic conjunctivitis
D. Frequent swimming

A

Recent URI

An upper respiratory tract infection can lead to sinus infections, which may subsequently spread to the orbital area, increasing the risk of orbital cellulitis.

59
Q

A 6-month-old female infant is brought to the clinic by her parents as a new patient for well-child examination. The patient was delivered at term and has been healthy. However, the parents are concerned that the patient sometimes seems cross eyed. Strabismus is suspected. Which test is most likely to confirm this diagnosis?

A

Cover Test

60
Q

What class of antibiotics is non-ototoxic and can be used in a tympanic membrane perforation?

A

Floxacin drops

Pediatrics EORE (12 decks)

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