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Special Pops - Peds > ENT > Flashcards

ENT Flashcards

1
Q

What can ptosis cause in children?

A
  • Obstructs visual axis

- Can cause permanent visual acuity loss (from deprivation amblyopia)

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2
Q

Treatment of nasolacrimal duct obstruction

A

Most clear spontaneously in 1st year

  • Massage over sac
  • Clean lids and medial canthal area
  • Topical abx if superinfection
  • Probing (80% success rate)
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3
Q

What is dacryocyctitis?

A
  • Infection of nasolacrimal sac

- Usually caused by upper respiratory tract bacteria (S aureus, S pneumo, S pyogenes, etc.)

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4
Q

How can dacryocyctitis be prevented?

A

Treat nasolacrimal duct obstruction

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5
Q

Describe hyphema

A
  • Layer of blood in anterior chamber

- Can be microscopic or fill entire chamber

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6
Q

What are hyphemas caused by?

A

Blunt trauma to globe

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7
Q

Who is at high risk for hyphema?

A

Sickle cell anemia or trait

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8
Q

Potential complications of hyphema

A
  • Increased IOP
  • Glaucoma
  • Permanent corneal staining
  • Vision loss
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9
Q

Treatment of hyphema

A
  • Shield placed over eye
  • Head elevated
  • Ophtho referral
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10
Q

What is an iris coloboma?

A

Developmental defect due to incomplete closure of the anterior embryonal fissure

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11
Q

PE finding of iris coloboma?

A

Pupils reveal “keyhole” shape on penlight exam

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12
Q

What indicates retinal involvement of an iris coloboma?

A

Poor vision upon exam

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13
Q

What is aniridia?

A
  • Absence of majority of the iris

- Autosomal dominant disorder OR can be a/w Wilms tumor

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14
Q

What can aniridia be associated with?

A

Wilms tumor

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15
Q

What is glaucoma caused by and what does it result in?

A
  • Caused by increased IOP

- Results in vision loss d/t optic nerve injury, corneal scarring and amblyopia

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16
Q

Signs of glaucoma in the 1st year of life

A
  • Buphthalmos (enlargement of globe d/t low scleral rigidity in the infant eye)
  • Tearing
  • Photophobia
  • Blepharospasm
  • Corneal clouding
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17
Q

Signs of glaucoma after 3 yo

A

Usually only optic nerve changes occur

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18
Q

What is iridocyclitis and what is it associated with?

A
  • Inflammation of iris and ciliary body
  • Juvenile idiopathic arthritis (MC girls w/pauciarticular arthritis)
  • IBD (MC Crohn’s)
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19
Q

Clinical presentation of iridocyclitis

A
  • May be asymptomatic

- Injection, photophobia, pain,

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20
Q

What is the MC primary intraocular malignancy of childhood?

A

Retinoblastoma

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21
Q

Clinical presentation of retinoblastoma

A
  • Most present before 3 yo

- MC presenting sign is leukocoria

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22
Q

What is papilledema characterized by?

A
  • Blurred optic disc edges
  • Flame hemorrhages
  • Enlarged physiologic blind spot
  • Visual acuity NORMAL
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23
Q

Purpose of orbital septum?

A

Helps to decrease risk of an eyelid infection from extending into the orbit

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24
Q

Define orbital cellulitis

A

Infection posterior to orbital septum

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25
Q

What conditions can cause nystagmus in children?

A
  • Esotropia (crossed eyes)
  • Ocular lesions that cause deprivation amblyopia (e.g. ptosis)
  • Hypoplastic visual pathways (aka “sensory” nystagmus)
  • Can also occur with normal ocular structures (called “motor” nystagmus)
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26
Q

What is the MC origin of nystagmus in childhood?

A

Ocular

but CNS and inner ear disease can be causes

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27
Q

Define strabismus

A

Misalignment of the eyes

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28
Q

What can cause strabismus?

A

Amblyopia

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29
Q

Describe pseudoesotropia

A

Results from prominent epicanthal folds that give the appearance of crossed eyes when they are actually straight

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30
Q

What needs to be ruled out if there is acute onset of esotropia after 5 yo?

A

CNS disease

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31
Q

Treatment of esotropia

A
  • Glasses with or w/o bifocals
  • Amblyopia treatment
  • Surgery
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32
Q

How can strabismic amblyopia occur?

A

In nondominant eye of a strabismic child

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33
Q

How can refractive amblyopia occur?

A

In both eyes if significant refractive errors are untreated

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34
Q

How can deprivation amblyopia occur?

A

Dense cataracts or complete ptosis prevents formation of a formed retinal image

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35
Q

Define amblyopia

A

Unilateral or bilateral reduction in vision due to strabismus, refractive errors and/or visual deprivation

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36
Q

When does amblyopia occur?

A

Only during critical period of visual development (1st decade of life) when the visual nervous system is plastic

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37
Q

Treatment of amblyopia

A

Patching or fogging of the sound eye with cycloplegic drops/lenses/filters (forces nervous system to process input from the amblyopic eye)

38
Q

MC bacteria causing otitis externa?

A

S aureus

P aeruginosa

39
Q

Prevention of otitis externa?

A
  • One footed dance
  • 1:1 solution of white vinegar/70% ethyl alcohol before AND after water exposure
  • 2% acetic acid drops
40
Q

Ear plug prevention of otitis externa?

A

Potentially cause OE more than prevent

41
Q

How to determine presence of middle ear effusion (MEE)?

A
  • Bulging TM
  • Limited or absent mobility of TM
  • Air-fluid level behind TM
  • Otorrhea
42
Q

Risk factors for otitis media

A
  • Bacterial colonization of UR tract (children in daycare)
  • Viral URI
  • Smoke exposure
  • ET dysfunction
  • Impaired host immune defenses
  • Bottle feeding/pacifier
  • Genetic susceptibility
43
Q

What must be assessed upon examination for otitis media?

A

Mobility of TM!

44
Q

Treatment of otitis media

A
  • Pain management
  • Watchful waiting
  • Abx (Amoxicillin 1st line, Augmentin 2nd line)
45
Q

Prevention of otitis media

A
  • Abx prophylaxis (maybe)
  • Lifestyle modifications (tobacco, breast feeding, pacifiers, daycare)
  • Surgery (but WAIT at least 3 months)
  • Immune evaluation (allergy testing)
  • Vaccines (PCV13, influenza)
46
Q

Indications for PE tubes?

A
  • MEE persists for 4 or more months

- Bilateral hearing impairment of 20 dB or more

47
Q

Describe mastoiditis

A

Complication of otitis media BUT often no prior history of it (only 35%)

48
Q

MC clinical presentation of mastoiditis

A
  • Postauricular pain

- Down or outwardly displaced pinna (Dumbo ear)

49
Q

Treatment of mastoiditis

A
  • Myringotomy with or w/o tube followed by IV abx and (cipr)ofloxacin ear drops
  • Surgical drainage if no improvement in 24-48 hrs
  • Cortical mastoidectomy
50
Q

Congenital ear malformations:

A
  • Agenesis (atresia)
  • Microtia
  • Lop ears
  • Low set ears
  • Preauricular tags
51
Q

Define microtia

A
  • Congenital ear formation
  • External ear that is small, collapsed or only has an earlobe present
  • Often associated with aural atresia
52
Q

Describe “lop ears”

A
  • Congenital ear malformation
  • Folded down or protruding (Dumbo ears)
  • Taping is effective in 1st 72-96 hrs of life
  • Incisionless otoplasty
53
Q

Describe low set ear

A
  • Congenital ear malformation
  • Upper pole is below eyebrow level
  • Often a/w renal malformations (so renal US is recommended)
54
Q

How many URIs occur in young children?

A

Average 6-7 colds/year

55
Q

What increases the occurrence of URIs in young children?

A

Daycare attendance increases # of colds in a year

56
Q

Treatment of URI in children under 4-6 yo

A

OTC cold and cough have higher side effects than benefit - NOT recommended

57
Q

How does sinusitis present?

A

Persistent URI symptoms lasting 10 or more days OR worsening symptoms after initial period of improvement

58
Q

Evaluation of sinusitis

A
  • Gram stain of nasal discharge may not correspond

- Xray findings are non-specific

59
Q

Potential complications a/w sinusitis

A
  • Orbital preseptal/orbital cellulitis

- Osteitis of the frontal bone (Pott’s puffy tumor)

60
Q

Treatment of sinusitis

A
  • If mild/mod symptoms, not in daycare, no recent abx: amoxicillin
  • Severe symptoms, in daycare or on abx within 90 days: HIGH dose Augmentin
61
Q

Treatment of sinusitis if toxic or signs of CNS or invasive infection?

A

Hospitalized with nafcillin and 3rd generation cephalosporin

62
Q

What is choanal atresia?

A
  • Congenital disorder of the nose

- Back of nasal passage is blocked usually by abnormal bony or soft tissue

63
Q

How does bilateral choanal atresia present?

A

Severe respiratory distress at birth

64
Q

How does unilateral choanal atresia present?

A

Usually appears later in life as a unilateral chronic nasal discharge

65
Q

What is bilateral choanal atresia associated with?

A

50% a/w CHARGE

  • Coloboma
  • Heart disease
  • Atresia of choanae
  • Retarded growth and development
  • Genital hypoplasia
  • Ear anomalies
66
Q

Symptoms of allergic rhinoconjunctivitis

A
  • Itching of nose, eyes, palate, pharynx
  • Paroxysmal sneezing, epistaxis, nasal crease
  • Nasal obstruction
  • Postnasal drip
  • Tearing, periorbital edema
  • Infraorbital cyanosis (allergic shiners)
67
Q

Treatment of allergic rhinoconjunctivitis

A
  • Avoidance of allergens

- Antihistamines, mast cell stabilizers, decongestants, montelukast, corticosteroids, immunotherapy

68
Q

What is the only form of therapy that alters disease process of rhinoconjunctivitis?

A

Immunotherapy (3-5 yr duration)

69
Q

Clinical presentation of infectious mononucleosis (EBV)

A
  • Exudative tonsillitis
  • Generalized cervical adenitis
  • Fever
  • Over 10% atypical lymphocytes on blood smear
  • EBV serology
70
Q

What is herpangina?

A
  • Acute febrile illness that causes pharyngitis

- Caused by Coxsackie group A virus

71
Q

Clinical presentation of herpangina

A

Herpanging ulcers (3 mm in size) surrounded by a halo on anterior tonsils, soft palate, uvula

72
Q

Describe hand, foot, and mouth disease

A
  • Caused by several enteroviruses

- Vesicles, pustules, papules on palms, soles, interdigital, buttocks

73
Q

What causes pharyngoconjunctival fever and how does it present?

A
  • Adenovirus (often epidemic)

- Exudative tonsillitis, conjunctivitis, lymphadenopathy

74
Q

About 10% of children with a sore throat and fever have what type of infection?

A

Group A strep

75
Q

What is the only way to make a definitive diagnosis of strep pharyngitis?

A

Throat culture or rapid antigen test

76
Q

Rapid antigen tests for strep pharyngitis

A
  • Very specific but 85-95% sensitivity
  • Positive indicates S pyogenes
  • Negative result requires confirmation by culture
77
Q

Untreated group A strep infection may result in:

A

Scarlet fever

78
Q

Possible complication of strep pharyngitis

A

PANDAS (pediatric autoimmune neuropsych disorders associated with strep) - OCD and/or tics

79
Q

Describe the strep pharyngitis carrier state

A
  • Harmless
  • Self limited (2-6 months)
  • Not contagious
80
Q

What do most unilateral, solitary anterior cervical nodes indicate?

A

70% due to hemolytic strep infection

20% due to staph

81
Q

What is the MC cause of indolent mildly tender adenopathy?

A

Cat scratch disease (caused by B henselae)

82
Q

What is the pathogen of cat scratch disease?

A

Bartonella henselae

over 90% of pts have history of contact with kittens

83
Q

Define early childhood caries (ECC)

A

Presence of one or more decayed, missing or filled tooth surfaces in any primary tooth in a child 6 or under

84
Q

Who is MC affected by early childhood caries?

A
  • Children who have routinely been given a nursing bottle when going to sleep
  • Prolonged at-will breast feeding
85
Q

Define caries

A
  • Bio-film (plaque) induced acide demineralization of enamel or dentin
  • Interaction of cariogenic organisms and fermentable carbs may induce demineralization
86
Q

What is most important when determining ECC risk?

A

FREQUENCY of sugar ingestion rather than quantity

87
Q

Cariogenic bacteria:

A

Mutans strep and lactobacilli

88
Q

How do children receive the most cariogenic bacteria?

A

Mother’s or primary caregiver’s mouth (kissing, sharing utensils, orally cleaning pacifier)

89
Q

Cariogenic vs. periodontal bacteria

A
  • Cariogenic: acid producing and tolerant
  • Periodontal: Gram negative, anaerobic, effects tissue health through inflamm host response or by producing proteases and cytotoxins
90
Q

Role of fluoride with teeth

A

Inhibits loss of minerals from tooth enamel and encourages remineralization

91
Q

Describe water fluoridation

A

CDC recognized as one of 10 great public health achievements of 20th century

Special Pops - Peds (10 decks)

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