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Rotation 1: Pediatrics > ENT/Ophthalmology (15%) > Flashcards

ENT/Ophthalmology (15%) Flashcards

1
Q

What are some clinical manifestations of a patient with strabismus?

A

Diplopia

Scotomas

Amblyopia (“lazy eye”)

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2
Q

What is the centor criteria?

A
  1. fever
  2. phayngotonsillar exudates
  3. tender ANTERIOR cervical lymphadenopathy
  4. NO cough

Each one is assigned 1 point, 2-3 = cx, 4-5 = abx, (modified, add 1 pt if pt is <15 y/o)

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3
Q

What are the three main types of rhinitis?

Which one is the most common type overall?

A

Allergic (MC)

Infectious

Vasomotor

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4
Q

What may be seen on physical exam of a patient with allergic conjunctivitis?

What kind of discharge?

Bilateral or unilateral?

What is chemosis?

A

“COBBLESTONE MUCOSA” appearance to the inner/upper eyelid, itching, tearing, redness, stringy discharge

Usually bilateral

± Chemosis (conjunctival swelling)

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5
Q

What is the most common source/site of anterior epistaxis?

A

Kiesselbach’s plexus

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6
Q

Is anterior or posterior epistaxis more common?

A

Anterior

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7
Q

What is otitis externa more commonly referred to as?

What is it due to?

What is the most common infectious agent to cause otitis externa?

A

“Swimmer’s ear”

Excess water or local trauma that changes the normal acidic pH of the ear, causing bacterial overgrowth

Pseudomonas

also: Proteus, S. aureus, S. epidermis, GABHS, anaerobes (Peptostreptococcus); Aspergillus

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8
Q

What is mastoiditis?

A

Inflammation of the mastoid air cells of the temporal bone

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9
Q

What are potential risk factors/causes of anterior epistaxis?

Posteroir epistaxis?

A

Anterior: nasal trauma (nose picking, blowing nose forcefully), low humidity in a hot environment (dries nasal mucosa), rhinitis, ETOH, antiplatelet meds

Posterior: HTN and atherosclerosis

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10
Q

How do you dx a TM perforation?

What may a perforation lead to?

What kind of hearing loss can a TM perf cause?

A

Otoscopic examination

May lead to cholesteatoma development

± conductive hearing loss

Weber: lateralization to affected ear

Rinne: BC>AC (-)

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11
Q

What is the pathophysiology behind AOM?

What typically precedes AOM? What does this cause?

A

URI causes eustachian tube edema, which leads to negative pressure and transudation of fluid and mucus in the middle ear, which leads to secondary colonization by bacteria and flora

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12
Q

How do you diagnose a patient with strabismus? Screening? Determine angle?

Tx?

If severe or unresponsive to conservative therapy?

What may occur if strabismus is not treated before 2 y/o?

A

Hirschberg corneal light reflex testing, often used as screening test

Cover-uncover test to determine the angle of strabismus

  1. Patch therapy: normal eye is covered to stimulate & strengthen the affected eye. Eyeglasses.
  2. Corrective surgery if severe or unresponsive to conservative therapy.

If not tx <2 y/o, amblyopia may occur = decreased visual acuity not correctable by refractive means

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13
Q

What is the recommended tx for otitis externa?

What if there is also a TM perforation?

What should the ear be protected from?

What if the infection is fungal–what to tx with?

A

Topical Abx: Ciprofloxacin/dexamethasone (Ofloxacin safe if there is an associated TM perforation).

Aminoglycoside combination: Neomycin/Polytrim-B/Hydrocortisone otic (not used if TM perforation is suspected - aminoglycosides are ototoxic )

Protect ear against moisture (drying agents include isopropyl alcohol and acetic acid)

Amphotericin B if fungal

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14
Q

What will be seen on PE in a pt with AOM?

What does it mean if there are bullae on the TM?

A

Bulging, erythematous TM with effusion

Loss of landmarks

DECREASED TYMPANIC MEMBRANE MOBILITY on pneumatic otoscopy

lf bullae on TM = suspect Mycoplasma pneumoniae

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15
Q

What are some potential sx that a patient may present with if they have a peritonsillar abscess?

A

dysphagia, pharyngitis, muffled “HOT POTATO VOICE”

difficulty handling oral secretions, trismus, UVULA DEVIATION TO CONTRALATERAL SIDE, tonsillitis, anterior cervical lymphadenopathy

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16
Q

Epiglottis is a medical emergency and mortality is usually secondary to ______

A

asphyxiation

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17
Q

You should suspect epiglottitis in patients who present with rapidly developing ____, ____ voice, and ______ out of proportion to physical findings

A

pharyngitis

muffled

odynophagia

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18
Q

What is the cause of vasomotor rhinitis?

A

Nonallergic/noninfectious dilation of the blood vessels (i.e. from temperature changes)

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19
Q

What is malignant otitis externa?

What is it secondary to?

What population of patients is this condition most common in?

A

Osteomyelitis at skull base secondary to Pseudomonas

MC seen in DM and immunocompromised pts

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20
Q

What is the first line test for diagnosing peritonsillar abscess?

A

CT scan to differentiate cellulitis from an abscess

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21
Q

What are the 4 most common organisms that cause AOM?

These are the same organisms that also cause _______.

Peak age?

A

S. pneumo (MC), H. influenza, Moraxella catarrhalis, Strep pyogenes

same organisms seen in acute sinusitis

Peak age 6-18 months

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22
Q

What is oral candidiasis/thrush caused by?

How does it manifest in a patient?

A

Candida albicans (part of the normal flora and can become pathogenic due to immunosuppression)

HIV, chemotherapy, use of steroid inhalers w/o spacer, abx use, diabetics, denture use

Mouth or throat pain

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23
Q

What are the sx of a TM perforation?

A

Acute ear pain, hearing loss, +/- bloody otorrhea, +/- tinnitus/vertigo

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24
Q

What will a pt with mastoiditis complain of? Have a hx of?

What will be appreciated on PE?

What are potential complications of mastoiditis?

A

Deep ear pain (usually worse at night), fever

Mastoid tenderness, may develop cutaneous abscess (fluctuance)

Complications: hearing loss, labyrinthitis, vertigo, CN VII paralysis, brain abscess

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25
What is the most common site/source of posterior epistaxis?
Palatine artery ## Footnote *may cause bleeding in both nares and posterior pharynx*
26
How to tx bacterial conjunctivitis? What should be given if the patient is a contact lens wearer? Why? What should be done if the infectious organism is gonorrhea? Chlamydia?
1. ***_Topical antibiotics_***: Erythromycin, Fluoroquinolones (ex. Moxijloxacin), Sulfonamides, Aminoglycosides. If _contact lens wearer_, cover ***Pseudomonas*** (Fluoroquinolone or Aminoglycoside) 2. If ***Chlamydia*** or ***Gonorrhea***, ± admit for IV and topical Abx (***_ophtho emergency_***). **No Steroids**. Gonoccoccal conjunctivitis: IV Ceftriaxone Chlamydia: Azithromycin
27
What is seen on PE in a patient with oral candidiasis/thrush? What will be see on KOH?
***white curd-like plaques*** ***_± LEAVE BEHIND ERYTHEMA/BLEEDS IF SCRAPED_*** KOH smear will show *_budding yeast and pseudohyphae_*
28
A patient with allergic conjunctivitis may present with conjunctival _______ and perhaps other ____ sx such as ...
conjunctival erythema allergic sx i.e. rhinorrhea, etc
29
What position might a patient with epiglottitis assume on observation?
Tripod
30
What are the 3 Ds of epiglottitis?
Dysphagia, Drooling, and Distress
31
What is the treatment of malignant otitis externa?
***_IV antispseudomonal Abx_*** Ceftazidime or Piperacillin + Fluoroquinolones or Aminoglycoside
32
Allergic rhinitis is associated with ____ \_\_\_\_ and tends to be worse in the (morning/afternoon/evening)
nasal polyps morning
33
What may a patient's ear with otitis externa look like on physical exam? What will there be pain with?
PAIN ON TRACTION OF THE EAR CANAL/TRAGUS external auditory canal erythema/edema/debris
34
How do you treat a patient with orbital cellulitis?
**_IV antibiotics_**: Vancomycin, Clindamycin, Cefotaxime, Ampicillin/sulbactam
35
What is the most common bacterial cause of acute pharyngitis/tonsilitis?
GABHS (strep pyogenes)
36
What is the recommended tx of viral conjunctivitis?
**_Supportive_** (cool compresses, artificial tears) +/- antihistamines
37
What sx do patients with AOM typically present with? Infants? If TM perforates?
Fever, ***_otalgia_*** (ear pain), conductive hearing loss, stuffiness EAR TUGGING in infants If TM perforation = ***rapid relief of pain*** + otorrhea (usually heals in 1-2 days)
38
What is the most common viral cause of infectious rhinitis? Less common bacterial causes?
**_Rhinovirus_** (*the common cold*) GABHS and Strep
39
SeptaI hematoma is associated with loss of _____ if the hematoma is not removed
cartilage
40
Orbital cellulitis is usually secondary to \_\_\_\_\_\_, caused by infectious agents such as... What else may cause orbital cellulitis? In what age group does this most commonly occur in?
Usually secondary to ***_sinus infections_*** (e**thmoid 90%**) *S. aureus, S. pneumo, GABHS, H.flu* May be caused by _dental/facial infections_ or _bacteremia_ MC occurs in ***children*** (especially **7-12 y/o**)
41
What is the most common cause of viral conjunctivitis? What is the most common source?
Adenovirus Swimming pools
42
Is viral or bacterial the more common cause of acute pharyngitis/tonsilitis?
Viral
43
What is mastoiditis usually a complication of? Do all patients with AOM have some degree of mastoiditis? Why/Why not?
Usually a complication of ***_prolonged or inadequately treated otitis media_*** **YES**. All patients with acute otitis media have some degree of mastoiditis because the mastoid and middle ear are connected
44
What infectious agent is most commonly responsible for viral conjunctivitis?
Adenovirus
45
What are clinical manifestations of otitis externa? History of? Is hearing compromised?
1-2 days of ear pain, pruritus in the ear canal, auricular discharge, pressure/fullness May have recent activity of ***swimming*** _**Hearing usually *preserved***_
46
What is the recommended course of tx for acute pharyngitis/tonsilitis?
*_Symptomatic_*: fluids, warm saline gargles, topical anesthetics, lozenges, NSAIDs Abx if *S. pyogenes*: **Penicillin**, Amoxicillin PCN allergy: Erythromycin or Clindamycin
47
What sx accompany acute pharyngitis/tonsilitis?
**_Sore throat_**, pain or swallowing or w/ phonation ## Footnote *Other sx based on the etiology*
48
What are possible etiologies of sensorineural hearing loss? What is the most common cause of sensorineural hearing loss?
Inner ear disorders: ex presbyacusis, chronic loud noise exposure, CNS lesions (ex acoustic neuroma), Labyrinthitis, Meniere syndrome. **_PRESBYACUSIS_** MC CAUSE OF SENSORINEURAL HEARING LOSS
49
What is first line tx of epistaxis? What therapies may be adjunct to the first line therapy?
***_Direct pressure_*** x10-15 minutes w/ pt seated and **leaning forward** to reduce vessel pressure **_Topical decongestants/vasoconstrictors_** may be adjunctive therapy w/ direct pressure *Phenylephrine, Oxymetazoline nasal (Afrin), Cocaine* **Cautious use in pts w/ HTN**
50
What is preseptal cellulitis? How do you differentiate between preseptal and orbital cellulitis based on sx alone? Tx?
**Infection** of the _eyelid_ and _periocular_ _tissue_ --\> May have ocular pain and swelling but: ***_NO visual changes & NO pain with ocular movement_*** ***Amoxicillin*** if preseptal
51
What are possible etiologies of conductive hearing loss? What is the most common cause of conductive hearing loss?
External or middle ear disorders: defect in sound conduction (ex. obstruction from a FB or cerumen impaction), damage to ossicles (otosclerosis, cholesteatoma), mastoiditis, otitis media **_CERUMEN IMPACTION_** MC CAUSE OF CONDUCTIVE HEARING LOSS
52
What view of radiograph will be used to observe epiglottitis? What will be seen?
Lateral cervical radiograph Thumb/Thumbprint sign
53
What is the tx of choice for a patient with oral candidiasis/thrush?
***_Nystatin liquid_*** Clotrimazole troches, oral fluconazole
54
How do you dx a pt with strep throat? What is the gold standard?
**_Rapid antigen detection test_**: 95% specific but only 55-90% sensitive (most useful if positive, but if negative, throat cultures should be obtained especially in children 5-15y) **_Throat cx_**: definitive dx (gold standard)
55
What is 1st line tx for streptococcal pharyngitis?
***_PCN G or PCN VK 1st line_*** (Amoxicillin, Augmentin) *Macrolides if PCN allergic*
56
What is the most common age group for epiglottitis? Male or female more common?
3 months-6 years male 2x as common as females
57
What is the 1st line tx of AOM? 2nd line? Severe/recurrent cases? AOM with effusion? In children with recurrent AOM, what workups should be performed?
**_AMOXICILLIN_** TREATMENT OF CHOICE (x10-14 days), Cefixime in children 2nd line: **Augmentin** or Cefaclor *PCN allergic: Erythromycin-Sulfisoxazole, Azithromycin, Trimethoprim/Sulfamethoxazole* Severe/Recurrent cases: ***Myringotomy*** (surgical drainage) ***Tympanostomy*** if recurrent or persistent Otitis Media w/ effusion: _observation_ in most cases In children w/ recurrent otitis media = _iron deficiency anemia workup_ and _CT scan_
58
Do most or few perforated TMs resolve spontaneously? What is the recommended tx for a TM perf? What should be avoided while a TM perf is healing?
***_Most_*** perforated TMs heal ***_spontaneously_*** Follow up to ensure resolution, ± Surgical repair **_Avoid_** *water/moisture/topical aminoglycosides* in the ear while healing TM perf
59
What infectious agent is the most common cause of PTA?
**_GABHS (strep pyogenes)_** staph aureus, polymicrobial
60
If there is sensorineural hearing loss (inner ear), what is the Weber test result? Rinne test?
**_Weber_**: Lateralizes to NORMAL ear **_Rinne_**: Normal AC\>BC *Patient will have difficulty hearing their own voice and deciphering words* (sensori**_N_**eural lateralizes to **_N_**ormal ear + **_N_**ormal Rinne)
61
If there is conductive hearing loss (external/middle ear), what is the Weber test result? Rinne test?
Weber: Lateralizes to AFFECTED ear Rinne: (-) BC\>AC
62
Upon PE of a patient with allergic rhinitis, what would be observed?
PALE/VIOLACEOUS, BOGGY TURBINATES, nasal polyps with COBBLESTONE MUCOSA of the conjunctiva
63
What is the way to definitively diagnose a patient with epiglottitis? What will the epiglottitis look like?
Laryngoscopy Cherry red with swelling
64
What is another name for peritonsillar abscess?
Quinsy
65
What is streptococcal pharyngitis caused by?
**GABHS** (aka strep pyogenes)
66
How do you definitively dx a pt with orbital cellulitis?
***_High resolution CT scan_***: infection of the fat and ocular muscles ## Footnote **MRI**
67
What color turbinates are observed in viral rhinitis?
Erythematous
68
Do patients with orbital cellulitis have normal visual acuity? Pain? What is proptosis?
**DECREASED VISION** *_PAIN_* WITH OCULAR MOVEMENT **_Proptosis_** (*bulging eye*) eyelid erythema and edema
69
In what type of rhinitis would intranasal corticosteroids be helpful in?
Allergic
70
What is the tx for allergic conjunctivitis?
1. **_Topical Antihistamines_** {*H1 blockers*}: **Olopatadine** (Patanol/Pataday - antihistamine/mast cell stabilizer), **Pheniramine**/**Naphazoline** (Naphcon A - antihistamine/decongestant), Emedastine 2. Topical NSAIDs: Ketorolac. 3. Topical corticosteroids. Side effect of long term steroid use: glaucoma, cataracts , HSV keratitis
71
Tonsillitis --\> ______ --\> abscess formation
cellulitis
72
Will patients with epiglottitis have inspiratory or expiratory stridor?
Inspiratory stridor
73
What is the mainstay of tx for a pt with epiglottitis?
Maintain the airway! Supportive management *Place child in a comfortable position and keep the child calm to avoid airway issues. Dexamethasone to reduce airway edema. Tracheal intubation to protect the airway in severe cases.* Abx: 2nd/3rd generation cephalosporins (ceftriaxone or cefotaxime)
74
Non Hib causes of epiglottitis are most commonly seen in what population?
adults, especially in pts who use crack cocaine
75
What is the recommended course of tx of PTA?
***_Abx + aspiration or I&D_*** _Tonsillectomy indications_: recurrent strep infections, recurrent peritonsillar infections, chronic tonsillitis
76
What is the hallmark of tx for mastoiditis? Other tx options? What can be performed to obtain a middle ear culture? For refractory or complicated mastoiditis?
***_IV abx_*** + ***_middle ear/mastoid drainage_*** hallmark of tx **Ear / Mastoid drainage**: myringotomy w/ or w/o tympanostomy tube placement **Tympanocentesis** can be performed to obtain a middle ear cx IV abx: same antibiotics as AOM (Amoxicillin) Refractory or complicated mastoiditis = **mastoidectomy**
77
What is another name for neonatal conjunctivitis?
Ophthalmia neonatorum
78
What kind of discharge is associated with bacterial conjunctivitis? Are there visual changes? What is there an absence of? What would need to be done to detect corneal abrasions or keratitis?
PURULENT DISCHARGE, LID CRUSTING Usually **no visual changes** (mild pain). Absence of _ciliary injection_. **Fluorescein staining** needed to detect corneal abrasions or keratitis.
79
Why does AOM present more commonly in young children as opposed to adults? What risk factors predispose one child versus another child to AOM?
***_Eustachian tube (ET) dysfunction_*** (ET is **wider**, **shorter** & more **horizontal**) Day care, pacifier/bottle use, parental smoking, not being breastfed
80
On physical exam, what would one expect to find in a patient with viral conjunctivitis? Bilateral or unilateral? What may be seen on slit lamp examination?
PREAURICULAR LYMPHADENOPATHY, copious watery discharge, scanty mucoid discharge. Often **_bilateral_** May have PUNCTATE STAINING on slit lamp examination
81
What are potential complications of streptococcal pharyngitis? Which complications are and are not precentable with abx?
**_Rheumatic fever_** (*preventable w/ abx*) **_Glomerulonephritis_** (*not preventable w/ abx*) Peritonsillar abscess Cellulitis
82
Patients with viral conjunctivitis often complain of a _____ \_\_\_\_\_ sensation in their eye, accompanied by physical exam findings of \_\_\_\_, and ____ vision.
foreign body erythema normal vision
83
In what population is viral conjunctivitis most common? Is viral conjunctivitis contagious?
Children YES! highly contagious
84
What is the cause of allergic rhinitis?
IgE mediated mast cell histamine release
85
How long is the normal course of illness for strep pharyngitis? The course is shortened by ___ hours with treatment in order to prevent complications, such as ____ \_\_\_\_
3-5 days 48 hours rheumatic fever
86
What is the recommended tx for allergic rhinitis? If a pt uses intranasal decongestant for \>3-5 days, what may occur? What is the most effective medication for allergic rhinitis, esepcially with nasal polyps? What type of rhinitis can mast cell stabilizers be used for? Anticholinergics will help with what sx?
***_Avoidance_*** and environmental control, exposure reduction ***_Oral antihistamines_***: decreases itching, sneezing, pruritus & rhinorrhea (little effect on congestion) * Nonsedating: Cetirizine, Fexofenadine, Loratadine* * Minimally sedating: Desloratadine* * Sedating: Brompheniramine, Chlorpheniramine, Hydroxyzine, Diphenhydramine* ***_Decongestants_***: MOA = improve congestion (little effect on rhinorrhea, sneezing, pruritus) * Intranasal: Oxymetazoline, Phenylephrine, Naphazoline* * Oral: Pseudoephedrine* Intranasal decongestants used \>3-5 days may cause **_rhinitis medicamentosa_** (***rebound congestion***) Intranasal steroids: most effective med for allergic rhinitis (especially with nasal polyps) _Mast cell stabilizers_ can be used in ***allergic rhinitis*** _Anticholinergics_ may help for ***rhinorrhea***
87
How to perfrom Weber test? Rinne test? Normal findings for each?
**_Weber test_**: Place tuning fork on top of head *Normal Weber* = No lateralization **_Rinne test_**: Place tuning fork on mastoid process *Normal Rinne* = (+) AC \> BC
88
What are some examples of viruses that can cause acute pharyngitis/tonsilitis?
Adenovirus, Rhinovirus, Enterovirus, Epstein-Barr virus, RSV, Influenza A & B, Herpes zoster virus
89
What is TM perforation most commonly caused by? Where does it most commonly occur on the membrane?
Due to **_penetrating/noise traumas_** Most commonly occurs at the ***pars tensa***
90
What infectious organism most commonly causes bacterial conjunctivitis?
***_Staph aureus_*** ***_Strep pneumoniae_*** *H. influenza*
91
If Ophthalmia neonatorium is noted on the first day after delivery, what is the most likely cause? Days 2-5? Days 5-7? Days 7-11?
Silver nitrate gonococcal chlamydia HSV
92
What is strabismus? What is esotropia? Exotropia? Hypotropia? Hypertropia?
Misalignment of the eyes ***_Esotropia_***: convergent strabismus, deviated inward ("crossed eyed") ***_Exotropia_***: divergent strabismus, deviated outward Down Up
93
Where does acute otitis media manifest? What is it usually preceded by? Rapid or gradual onset?
Infection of middle ear, temporal bone, and mastoid air cells MC preceded by **_viral URI_** ***Rapid***
94
What sx are typical in a pt with rhinitis?
Sneezing, nasal congestion/itching, ***_clear rhinorrhea_*** ## Footnote *Eyes, ears, nose, and throat may be involved*
95
What are other tx options for epistaxis?
**_Cauterization_**: silver nitrate if other measures failed and the bleeding site can be seen **_Nasal packing_**: if direct pressure and vasoconstrictors are unsuccessful or in severe bleeding **_Adjunct therapy_**: avoid *exercise* for a few days, avoid *spicy* foods (they cause vasodilation) Bacitracin and humidifiers helpful to moisten the nasal mucosa
96
If Ophthalmia neonatorium is left untreated, what complications might ensue?
corneal ulceration, opacification, blindness
97
What is the most common infectious organism that causes epiglottitis?
Hemophilus influenza type B (HiB)
98
What are the three types of conjunctivitis?
Viral Allergic Bacterial
99
What is the first line diagnostic test for mastoiditis?
CT scan

Rotation 1: Pediatrics (13 decks)

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