ENT lecture Flashcards
Must measure head circumference at each visit up until ____ months
36
Anterior fontanelle closes between ___-___ months
10-24 months
Posterior fontanelle closes by….
2 months
Visible pulsations in the anterior fontanelle can be normal, but it may be a sign of…
increased intracranial pressure
A depressed anterior fontanelle can indicate..
Dehydration and malnutrition
- Microcephaly (decreasing head circumference)
- Craniosynostosis (ridging at suture lines)
- Hyperthyroidism
- Hypophosphatasia
- Hyperparathyroidism
these can cause…
premature closure of the fontanelles
(but premature closure can also be normal)
- Primary megalencephaly
- Congenital hypothyroidism
- Elevated intracranial pressure
- Down syndrome
- Rickets
these can cause….
delayed closure of anterior fontanelle
- Premature fusion of cranial sutures
- Occurs 1 in 2000 births
- Affects sagittal >coronal>metopic>lambdoid sutures
- Seldom involves multiple sutures
-More common twins and infants born to mothers with
uterine abnormalities
Craniosynostosis
(complications= increased ICP, inhibited brain growth, cognitive impairments)
- More frequent due to general adoption of supine sleeping for SIDS prevention
- Affects nearly half of infants between 7-12 weeks and resolves, without intervention, by age two in most cases
- The ear is displaced anteriorly from the flattened region which can help differentiate from craniosynostosis.
Positional Plagiocephaly
Anomaly of eye alignment which can occur in either eye and in any direction
Strabismus
Nasal deviation strabismus?
Temporal deviation strabismus?
Nasal= Eso
Temporal= Exo
-phoria strabisumus is present only when…
fixation is interrupted
-tropia strabismus is present…
without interruption
agonist muscles in both eyes receive equal innervation to ensure coordinated movement (eg: as right eye abducts the left eye will adduct)
Hering’s Law
agonist/antagonist muscle pairs within each eye receive reciprocal innervation.
(eg: as muscle in the right eye contracts its antagonist muscle will relax)
Sherrington’s Law
Occurs in 2-4%
Risks= family hx, low birth weight, prematurity
Conditions that Predispose:
Vision depirvation: severe ptosis, cataracts
Amblyopia
Strabismus
retinoblastoma
optic nerve hypoplasia
head trauma
cranial nerve palsies
orbital fracture
myasthenia gravis and Graves’ disease
…can all cause?
Secondary strabismus
Amblyopia occurs in what percentage of strabismus pts?
50%
Optical illusion seen in children with wide nasal bridge and large epicanthal folds in first year of life which results in hiding the nasal sclerae.
can be confirmed with corneal light reflex and cover/uncover test (will have normal alignment)
Pseudoesotropia
(MC type of pseudostrabismus)
MC site of foreign bodies
R nostril
Unilateral purulent nasal discharge
Epistaxis
Nasal obstruction
Mouth breathing
Foreign body sxs
Gm positive, alpha hemolytic bacteria
MAJOR invasive pathogen in children
Main causes:
Otitis media
Pneumonia
Bacteriemia
Meningitis
Streptococcus pneumoniae
Adheres to epithelial cells of nasopharynx
Secretes pneumolysin, which binds cholesterol and can form pores in cellular membranes
PREVNAR vaccine helps protect against
Strep Pneumoniae
Since the Prevnar vaccine, Moraxella Catarrhalis is a common cause of….
Otitis media
(clinically more mild than s.pnuemoniae)
PCN/amoxicillin resistant
Most frequent dx in sick children in US
most prevalent in infancy (6-18 mos)
risk factors:
Family hx
Daycare
Lack of breast feeding
Tobacco exposure
Acute otitis media (AOM)
S. pneumonia
H. influenzae
M. catarrhalis
common causes of…
Acute otitis media
This bacteria usuaslly casues bilateral otitis media or otitis media with conjunctivitis
increased frequency since Prevnar vaccine
H. influenzae
Tx pain with:
NSAIDs, acetominophen Auralgan drops (if older than 2)
Acute otitis media
First line otitis media antibiotic?
high dose Amoxicillin
If…..
pt has been on antibitoics in last month
pt has conjunctivitis
pt is on daily amoxicillin for chemoprophylaxis
DOC?
Augmentin!
(Amoxicillin/Clavulanate)
duration of high dose amoxicillin for AOM in kids under 5? kids over 6?
Kids under 5: high dose Amoxicillin for 10 days
Kids over 6: high dose Amoxicillin for 5-7 days
Preseptal cellulitis
Orbital cellulitis
Septic cavernous sinus thrombosis
Meningitis
Osteomyelitis of frontal bone
Brain abscess
all potential complications of?
Untreated bacterial sinusitis
Tx of bacterial sinusititis?
Augmentin
aka exanthem subitum
Caused by herpes virus 6
Sx:
High fever (>104) for 3-5 days
Irritability
Anorexia
Diffuse maculopapular rash as fever ends
Roseola
(tx= supportive)
Caused by Group A Strep
Sx:
sore throat
myalgias
abdominal pain
(usually no URI sxs)
Tx: Pen V or Amoxicillin
Strep Pharyngitis
Tx with antibiotics will decrease risk of….
Peritonsillar abscess
Mastoidits
Rheumatic ever
Risk of tranmission
Strep pharyngitis
Occurs 2-4 weeks after Group A Strep pharyngitis
Usually ages 5-15
Uncommon in US, leading cause of cardiovascular death <50 in developing world
Major sxs: migratory arthritis, pancarditis/valvulitis, CNS involvement, erythena marginatum, subcutaneous nodules
Minor sxs: arthralgias, fever, prolonged PR interval
Rheumatic Fever
Collection of pus between palantine tonsil and pharyngeal muscles
Often polymicrobial
MC deep neck infection in children
Peritonsillar Abscess
Sx:
“hot potato” voice
drooling
trismus (good to distinguish between pharyngitis)
ipsilateral ear pain
fatigue
decreased PO intake
Peritonsillar abscess
Causes mono
Herpesvirus
Symptomatic infection peaks 15-24
90-95% adults are seropositive
Ebstein Barr Virus
Malaise
Ha
Fever
Exudative tonsillitis
Pharyngitis
Posterior cervical lymphadenopathy
EBV
Dx:
CBC with dif showing increased atypical lymphocytes
Presence of heterophile antibodies (usually absent in kids under 24 mos)
EBV specific serology
Mono (EBV)
Is mono a highly contagious dz?
NO!
but can be transmitted vi saliva up to 18 months after infection and may be intermittently shed for decades
Replicates in oropharyngeal epithelial cells and is released into saliva and infected B cells in oropharynx and is spread thru lymphoreticular system
EBV
If an EBV pt is given Ampicillin, they may develop a rash
Is this rash an allergy?
NO
What type of lymphoma is EBV linked to?
Burkitt’s lymphoma
Must consider if kid is coughing >14 days, regardless of immunization status
gm neg coccobacillus Bordatella Pertussis
spread via respiratory droplets spread by coughing
incubation 1-2 weeks
highly contagious!!
Pertussis
Pts are infectious until completion on abx (cough may continue tho)
Paroxysmal: 2-6 weeks
coughing paroxysms worse
inspiratory whoop after coughing
Convalescent: weeks to months
cough worsens with intercurrent URIs
Catarrhal: 7-10 days, mild cough, runny nose, afebrile cough that worsens
Pertussis
In infants, may present as:
feeding difficulties, tachypnea, cough
paroxysms of cough that cause gagging, apnea, cyanosis and bradycardia
*infant can appear well in between episodes of coughing
Pertussis
Apnea
Pneumonia
Vomiting
Seizures
Death
Complications of pertussis (MC under 6 months)
Tx of pertussis if under 2 months
Azithro or erythro
(if vomiting develops within a month, must consider pyloric stenosis)
Pertussis tx for >2 months
Macrolides or TMP/SMX
(NO TMP/SMX FOR UNDER 2 MONTHS BC RISK OF KERNICTERUS)
Must avoid for tx in kids under 2 months with pertussis bc of risk of kernicterus
TMP/SMX
For pertussis vaccine, immunity wanes in….
5-10 years
(need Tdap booster)
Peak incidence in kids under 2 months
sx: fever, vomiting, irritabilty, lethargy, anorexia, HA, confusion, back pain
MC pathogens:
1-3 months: Group B Strep (ie E Coli)
3 months-10 years: S. pneumoniae, N. meningitidis
Bacterial meningitis
