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SD- Pediatrics > ENT lecture > Flashcards

ENT lecture Flashcards

1
Q

Must measure head circumference at each visit up until ____ months

A

36

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2
Q

Anterior fontanelle closes between ___-___ months

A

10-24 months

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3
Q

Posterior fontanelle closes by….

A

2 months

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4
Q

Visible pulsations in the anterior fontanelle can be normal, but it may be a sign of…

A

increased intracranial pressure

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5
Q

A depressed anterior fontanelle can indicate..

A

Dehydration and malnutrition

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6
Q
  • Microcephaly (decreasing head circumference)
  • Craniosynostosis (ridging at suture lines)
  • Hyperthyroidism
  • Hypophosphatasia
  • Hyperparathyroidism

these can cause…

A

premature closure of the fontanelles

(but premature closure can also be normal)

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7
Q
  • Primary megalencephaly
  • Congenital hypothyroidism
  • Elevated intracranial pressure
  • Down syndrome
  • Rickets

these can cause….

A

delayed closure of anterior fontanelle

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8
Q
  • 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

A

Craniosynostosis

(complications= increased ICP, inhibited brain growth, cognitive impairments)

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9
Q
  • 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.
A

Positional Plagiocephaly

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10
Q

Anomaly of eye alignment which can occur in either eye and in any direction

A

Strabismus

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11
Q

Nasal deviation strabismus?

Temporal deviation strabismus?

A

Nasal= Eso

Temporal= Exo

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12
Q

-phoria strabisumus is present only when…

A

fixation is interrupted

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13
Q

-tropia strabismus is present…

A

without interruption

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14
Q

agonist muscles in both eyes receive equal innervation to ensure coordinated movement (eg: as right eye abducts the left eye will adduct)

A

Hering’s Law

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15
Q

agonist/antagonist muscle pairs within each eye receive reciprocal innervation.

(eg: as muscle in the right eye contracts its antagonist muscle will relax)

A

Sherrington’s Law

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16
Q

Occurs in 2-4%
Risks= family hx, low birth weight, prematurity

Conditions that Predispose:
Vision depirvation: severe ptosis, cataracts
Amblyopia

A

Strabismus

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17
Q

retinoblastoma
optic nerve hypoplasia
head trauma
cranial nerve palsies
orbital fracture
myasthenia gravis and Graves’ disease

…can all cause?

A

Secondary strabismus

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18
Q

Amblyopia occurs in what percentage of strabismus pts?

A

50%

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19
Q

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)

A

Pseudoesotropia

(MC type of pseudostrabismus)

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20
Q

MC site of foreign bodies

A

R nostril

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21
Q

Unilateral purulent nasal discharge
Epistaxis
Nasal obstruction
Mouth breathing

A

Foreign body sxs

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22
Q

Gm positive, alpha hemolytic bacteria

MAJOR invasive pathogen in children
Main causes:
Otitis media
Pneumonia
Bacteriemia
Meningitis

A

Streptococcus pneumoniae

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23
Q

Adheres to epithelial cells of nasopharynx
Secretes pneumolysin, which binds cholesterol and can form pores in cellular membranes

PREVNAR vaccine helps protect against

A

Strep Pneumoniae

24
Q

Since the Prevnar vaccine, Moraxella Catarrhalis is a common cause of….

A

Otitis media

(clinically more mild than s.pnuemoniae)

PCN/amoxicillin resistant

25
Q

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

A

Acute otitis media (AOM)

26
Q

S. pneumonia
H. influenzae
M. catarrhalis

common causes of…

A

Acute otitis media

27
Q

This bacteria usuaslly casues bilateral otitis media or otitis media with conjunctivitis

increased frequency since Prevnar vaccine

A

H. influenzae

28
Q

Tx pain with:

NSAIDs, acetominophen
Auralgan drops (if older than 2)
A

Acute otitis media

29
Q

First line otitis media antibiotic?

A

high dose Amoxicillin

30
Q

If…..

pt has been on antibitoics in last month
pt has conjunctivitis
pt is on daily amoxicillin for chemoprophylaxis

DOC?

A

Augmentin!

(Amoxicillin/Clavulanate)

31
Q

duration of high dose amoxicillin for AOM in kids under 5? kids over 6?

A

Kids under 5: high dose Amoxicillin for 10 days

Kids over 6: high dose Amoxicillin for 5-7 days

32
Q

Preseptal cellulitis
Orbital cellulitis
Septic cavernous sinus thrombosis
Meningitis
Osteomyelitis of frontal bone
Brain abscess

all potential complications of?

A

Untreated bacterial sinusitis

33
Q

Tx of bacterial sinusititis?

A

Augmentin

34
Q

aka exanthem subitum
Caused by herpes virus 6

Sx:
High fever (>104) for 3-5 days
Irritability
Anorexia
Diffuse maculopapular rash as fever ends

A

Roseola

(tx= supportive)

35
Q

Caused by Group A Strep

Sx:
sore throat
myalgias
abdominal pain
(usually no URI sxs)

Tx: Pen V or Amoxicillin

A

Strep Pharyngitis

36
Q

Tx with antibiotics will decrease risk of….

Peritonsillar abscess
Mastoidits
Rheumatic ever
Risk of tranmission

A

Strep pharyngitis

37
Q

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

A

Rheumatic Fever

38
Q

Collection of pus between palantine tonsil and pharyngeal muscles
Often polymicrobial

MC deep neck infection in children

A

Peritonsillar Abscess

39
Q

Sx:

“hot potato” voice
drooling
trismus (good to distinguish between pharyngitis)
ipsilateral ear pain
fatigue
decreased PO intake

A

Peritonsillar abscess

40
Q

Causes mono
Herpesvirus
Symptomatic infection peaks 15-24
90-95% adults are seropositive

A

Ebstein Barr Virus

41
Q

Malaise
Ha
Fever
Exudative tonsillitis
Pharyngitis
Posterior cervical lymphadenopathy

A

EBV

42
Q

Dx:

CBC with dif showing increased atypical lymphocytes
Presence of heterophile antibodies (usually absent in kids under 24 mos)
EBV specific serology

A

Mono (EBV)

43
Q

Is mono a highly contagious dz?

A

NO!

but can be transmitted vi saliva up to 18 months after infection and may be intermittently shed for decades

44
Q

Replicates in oropharyngeal epithelial cells and is released into saliva and infected B cells in oropharynx and is spread thru lymphoreticular system

A

EBV

45
Q

If an EBV pt is given Ampicillin, they may develop a rash

Is this rash an allergy?

A

NO

46
Q

What type of lymphoma is EBV linked to?

A

Burkitt’s lymphoma

47
Q

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!!

A

Pertussis

48
Q

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

A

Pertussis

49
Q

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

A

Pertussis

50
Q

Apnea
Pneumonia
Vomiting
Seizures
Death

A

Complications of pertussis (MC under 6 months)

51
Q

Tx of pertussis if under 2 months

A

Azithro or erythro

(if vomiting develops within a month, must consider pyloric stenosis)

52
Q

Pertussis tx for >2 months

A

Macrolides or TMP/SMX

(NO TMP/SMX FOR UNDER 2 MONTHS BC RISK OF KERNICTERUS)

53
Q

Must avoid for tx in kids under 2 months with pertussis bc of risk of kernicterus

A

TMP/SMX

54
Q

For pertussis vaccine, immunity wanes in….

A

5-10 years

(need Tdap booster)

55
Q

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

A

Bacterial meningitis

SD- Pediatrics (11 decks)

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