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EOR - Pediatrics (Alice copy + Seth's) > ENOT/OPHTHALMOLOGY (Seth's Additional info) (15%) > Flashcards

ENOT/OPHTHALMOLOGY (Seth's Additional info) (15%) Flashcards

1
Q

What is the MC reason children receive ABX in the US?

A

AOM

More than 90% of all antibiotic use in the first 2 years of life is due to OM

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2
Q

what is the pathophys of AOM

A

Inflammatory fluid and pathogenic respiratory bacteria that reflux into the middle ear space do not drain properly
This process effectively leads to the formation of an abscess in the middle ear

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3
Q

Exposure to this environmental hazard is a RF for AOM

A

Second hand smoke exposure

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4
Q

The _______ is shorter and more horizontal in infants and small children, which is a RF for AOM

A

Eustachian tube

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5
Q

This common action in young kiddos increases the likelihood of AOM

A

Pacifier use

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6
Q

Why can Pacifier use lead to AOM?

A

sucking on a pacifier increases the reflux of nasopharyngeal secretions into the middle ear, i.e. during a common cold pathogens can enter the middle ear more easily through this route.

the use of a pacifier may induce changes in dental structure and thereby dysfunction of the Eustachian tube

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7
Q

What age involves immediate treatment of AOM?

A

< 6 months

6-24 months can observe, but will need traetment

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8
Q

For AOM, if you are over the age of ___ you have the option of initially observing if mild s/s

A

24 months

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9
Q

1st line treatment of AOM and 2nd line if that does not work

A

Amoxicillin
Augmentin if refractory

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10
Q

Treatment for AOM if non IgE mediated reaction vs IgE mediated reaction

for allergies

A

Cefdinir (non-IgE)
Macrolide/clinda/bactrim (IgE)

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11
Q

If you do not have systemic symptoms and you have ______, you can use drops (cipro/ofloxacin) for AOM

A

tympanostomy tubes

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12
Q

Two complications of AOM

A

Tympanosclerosis (white plaque on TM from chronic inflammation)
Cholesteatoma (a greasy-looking or pearly white mass seen in a retraction pocket,
Occasionally with perforation, a temporary conductive hearing loss may be present)

for cholesteatoma

  • Most perforations heal within 2 weeks
  • When fail to heal within 3-6 months, surgical repair is indicated
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13
Q

If OM lasts > ___ it is chronic

A

3 months

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14
Q

treatment of recurrent OM and MOA

A

Tympanostomy tubes

Allows for drainage and decreases OM episodes; creates an airway that ventilates the middle ear and prevents the accumulation of fluid behind middle ear

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15
Q

MCC of strep pharyngitis is group ___ strep

A

Group A

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16
Q

pathophys of allergic rhinitis

A

Complex inflammatory disease of the upper airways, mediated by Immunoglobulin E (IgE)

type 1 hypersensitivity reaction

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17
Q

very strong RF for alergic rhinitis

A

Asthma

In patients with asthma, allergic rhinitis prevalence is > 80%

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18
Q

T/F, as you enter middle adulthood, allergic rhinitis worsens

A

FALSE
Peak in childhood and adolescence before the 4th decade

diminishes gradually with aging

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19
Q

MC gender for allergic rhinitis

A

Male

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20
Q

Accentuated lines of the eyes seen in allergic rhinitis are called:

A

Dennie-Morgan lines

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21
Q

The Nasal mucosa of allergic rhinitis is pale, with a ___ hue and ___ d/t venous engorgement

A

The Nasal mucosa of allergic rhinitis is pale, with a bluish hue and boggy d/t venous engorgement

also see Cobblestoning and nasal polyps (think obstructive symptoms)

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22
Q

What is a positive pick test for allergic rhinitis (basically allergies in general)

A

wheal 5 mm or greater

NO ANTIHISTAMINES PRIOR TO TESTING for at least 5 days

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23
Q

What is a mild, intermittent allergic rhinitits?
< __ days/week
< ___ weeks
abscence of ___

A

<4 days/week
<4 weeks
does not greatly affect QOL

if different timing, then persistent
if affects QOL, then mod/severe

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24
Q

Most effective treatment for allergic rhinitis (suffix?) and when to treat

A

intranasal glucocorticoids (-asone)

if persistent or mod/severe

Down regulates inflammatory response - decreases swelling of nasal mucosa

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25
Q

Although not as effective, this class of meds is first line for mild/intermittent symptoms (suffix)

A

H1 antihistamines (not as sedating)

-adine

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26
Q

MC organisms for bacterial conjunctitivitis

A

S pneomo
H flu
M Cat

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27
Q

MCC of viral conjunctivitis

A

Adenovirus

watery d/charge and HIGHLY contagious

starts in one eye and spreads to the other

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28
Q

t/f both allergic conjuntivitis and allergic rhinitis are type 1 hypersensitvity reactions

A

TRUE

treat allergic conjunctivitis with -tidine

most common in Spring

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29
Q

what is it called when there is a severe allergic reaction in the eyes, leading to:
Severe itching, tearing, mucus production
Giant papillae of upper tarsal conjunctiva
Ptosis and keratitis common, resulting in squinting in bright light
Papillae found at limbus (junction of sclera and cornea)
With characteristic white dots (represent accumulation of inflammatory cells, mostly eosinophils)

A

Vernal Keratoconjunctivitis

30
Q

t/f the treatment for Vernal Keratoconjunctivitis is the same as viral conjunctivitis

A

True

31
Q

Worry about untreated Vernal Keratoconjunctivitis

A

Permenant vision loss

32
Q

what is atopic conjunctivitis associated with?

A

Eczema

Tx same as allergic conjunctivitis

33
Q

what oropharyngeal disease can be prevented with HIB vaccine

A

Epiglottitis

MCC is H flu, remember

34
Q

What confirms the diagnosis of epiglottis

treatment?

A

Direct visulaization

xrays are NOT mandatory for dx

VR = treatment (vanc rocephin)

35
Q

Steps of mng for anterior epistaxis (5)

to stop bleed

A
  1. Pressure on site for 15 min + lean forward
  2. Short acting nasal decongestants/vasconstricors (phenylephrine)
  3. Topical anesthetic vasoconstrictor (cocaine/lidocaine and epi)
  4. Identified location, chemical cauteriaztion with silver nitrate or thermal cauterization
  5. Nasal packing with sponge/balloon OR absorable material like oxidized cellulose/gelatin
36
Q

Steps of mng for posterior epistaxis

to stop bleed

A
  1. ENT consult
  2. Packing/narcotic analgesics, ligation of nasal arterial supply, endovascular emobilaztion of internal maxillary artery
  3. ABX prophilaxis with Augmentin/clinda/keflex for antistaph TSS
37
Q

After control of epistaxis, what is some patient education to reduce instance of future bleeds

A
  1. Avoid vigorous exercise
  2. Avoid hot/spicy foods and tobacoo
  3. Lubrication with petrolatum or Bacitracin ointment
  4. Increase home humidity
38
Q

treatment of preseptal/periorbital cellulitis

A

Augmentin/cefdinir PLUS Bactrim/clinda

For preseptal, think preschool, where you learn your ABCs

(Augmentin, Bactrim, Clinda/cefdinir)

39
Q

treatment of peritonsillar abscess

A

I&D
IV Unasyn or IV clinda
IV Vanc if refractory

switch to oral abx later

40
Q

RFs that mean a neonate should be screened for hearing loss

A

infections
FHx
ENT defects

41
Q

Hearing Interventions should be in place by () age for social/language development

A

6 months of age

42
Q

All infants with or without risk factors should receive ongoing surveillance of communicative/ language development beginning at _ of age during well-child visits

A

2 months

43
Q

MCC of hearing loss in 2-5 yo

A

Recurrent OM

44
Q

Up until this age () behavioral and language responses are the gold standard of hearing screening. Once a child is () auidometry is preferred

A

birth to 3 = behavioral
4+ = auidometry

at 5 yo kids are often screened at school

45
Q

tympanic membrane ruptures typically resolve within () but a () may be necessary if no resolution

A

months
tympanoplasty (plastic on eardrum)

r/o infection as well and can treat with same ABX as AOM (amoxicillin, augmentin, cefdinir, oflaxacin, ciprodex)

46
Q

What cannot be used with an ruptured TM?

A

Cortisporin (Neomycin-polymyxin B-hydrocortisone)
Numbing drops
Olive oil

47
Q

what is mastoiditis typically a complication of?

A

several weeks of poorly treated AOM

same pathogens as a result

48
Q

What do mastoid air cells connect to?

A

Middle ear

fluid build up here without drainaige can lead to mastoiditis

49
Q

If ABX (VR) do not resolve mastoiditis, what is the next treatment plan?

A

Myringotomy

Surgical drainage of TM to allow drainage of middle ear fluid

50
Q

If ABX and myringotomy are refractory, what is the last resort treatment option of mastoiditis?

A

mastoidectomy and debridement of infected and necrotic bone

51
Q

MCC of ped visual impairment

A

Amblyopia

52
Q

What is amblyopia?

A

A functional reduction in the visual acuity of an eye, either unilaterally or bilaterally, caused by disuse or misuse during the critical period of visual development

53
Q

What are the 3 types of amblyopia

A

Strabismus
Refractive
Deprivational

54
Q

What is strabismus?

A

Type of amblyopia invloving misalignment of visual axes of the two eyes

55
Q

What is refractive amblyopia?

A

One or both eyes having a refractive error causing an imbalance between the eyes

56
Q

What is deprivational amblyopia?

A

Obstruction by a cataract or complete ptosis prevents formation of a formed retina

interruption of the visual axis or severe distortion of the foveal image

least common but most severe - cam lead to permenant visual impairment

57
Q

Pathophys of strabismic amblyopia

A

Dsicrepancy in the foveas of two eyes leading to unfusable images. The visual cortex suppresses the image from one eye in order to avoid having diplopia; long-term suppression of one eye results in strabismic amblyopia.

58
Q

Is refractive amblyopia MC in hyper/hypoopia?

A

hyperopia

far-sighted (where up-close images are out-of-focus)

the people that need reading glasses

59
Q

How do you check for amblyopia/strabismus in a pre-verbal child?

positive result?

A

Fixation reflex

amblyopia don’t fix on obj with amblyopic eye when both eyes uncovered

testing involves moving a visual target to and from the child’s visual space, each eye being tested by occluding the fellow eye

60
Q

How do you check for amblyopia/strabismus in a verbal child/ 3 and older?

A

Allen/snellen charts

eyes should be checked at three!!!

61
Q

Visual acuity is 20/40 at ____.
Visual acuity worse than 20/30 at ____ warrants evaluation/ referral.

A

20/40 at 3-5 yo = normal
worse than 20/30 at 6 = reffer

should have normal vision at 6 yo

62
Q

when does ocular instability of infancy resolve by?

A

3 months

may look like strabismus, but after 3 months you should be able to fix on an obj, making it go away

63
Q

What do you use to evaluate strabismus?

A

Corneal light reflex
Cover test
Cover/uncover test

64
Q

Explain the corneal light reflex

A

Accommodation target using a small toy used w/ the ophthalmoscope light standing several feet from the child.
Hold the light and toy in the same hand and use the light to reflect on both eyes at the same time

AKA: Hirschberg test

A normal test will reveal that the light reflects off the same position on each eye

65
Q

Explain the cover test associated with strabismus

A

The child is asked to visually fixate on a target at distance or near
The examiner briefly covers one eye while observing the opposite eye for movement

No movement is detected when covering either eye if the child has normal ocular alignment
Strabismus present if the eye that is not occluded with the cover test shifts to re-fixate on the target when the fellow, previously fixating eye is covered

66
Q

Explain the cover uncover test associated with strabismus

A

Child asked to visually fixate on a target at distance or near. A cover is placed over one eye for a few seconds and then it is rapidly removed
The eye that was under the cover is observed for refixation movement

If strabismus present, this previously covered eye will shift back into the straight-ahead position to re-establish sensory fusion with the other eye
A positive test occurs when the cover is rapidly removed and the affected eye is deviated. This eye will realign after the cover is removed to fixate on the object

67
Q

What is the reflex seen on opthalmoscope that is associated with strabismus on PE?

Describe it

A

Bruckner Red Reflex

AKA the simultaneous red reflex test

Positioned 18-20 inches from the child’s face, the ophthalmoscope with the largest diameter light is used to visualize both of the child’s red reflexes at the same time
The light should be positioned just around the skin of the child’s eyes and the child should be looking directly at the ophthalmoscope. The red reflexes should be equal in size, shape, color, and hue

68
Q

t/f constant strabismus in new borns is normal and does not merit referral

A

FALSE

intermittent is normal, not constant

69
Q

Constant strabismus at any age merits a referral. At what age do you refer if intermittent strabismus does not go away?

A

> 6 months of age

70
Q

t/f a positive corenal light reflex, cover, or cover/uncover test at any age merits a referral

A

TRUE

if negative, you can obs until 6 months

71
Q

Treatment of strabismus

A

Corrective lenses
Patching

consider sugery via recession (reposition muscle) or resection (shorten muscle)

EOR - Pediatrics (Alice copy + Seth's) (22 decks)

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