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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
Q

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

A

Palatine artery

may cause bleeding in both nares and posterior pharynx

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26
Q

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?

A
  1. Topical antibiotics: Erythromycin, Fluoroquinolones (ex. Moxijloxacin), Sulfonamides, Aminoglycosides.

If contact lens wearer, cover Pseudomonas (Fluoroquinolone or Aminoglycoside)

  1. If Chlamydia or Gonorrhea, ± admit for IV and topical Abx (ophtho emergency). No Steroids.

Gonoccoccal conjunctivitis: IV Ceftriaxone

Chlamydia: Azithromycin

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27
Q

What is seen on PE in a patient with oral candidiasis/thrush?

What will be see on KOH?

A

white curd-like plaques

± LEAVE BEHIND ERYTHEMA/BLEEDS IF SCRAPED

KOH smear will show budding yeast and pseudohyphae

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28
Q

A patient with allergic conjunctivitis may present with conjunctival _______ and perhaps other ____ sx such as …

A

conjunctival erythema

allergic sx

i.e. rhinorrhea, etc

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29
Q

What position might a patient with epiglottitis assume on observation?

A

Tripod

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30
Q

What are the 3 Ds of epiglottitis?

A

Dysphagia, Drooling, and Distress

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31
Q

What is the treatment of malignant otitis externa?

A

IV antispseudomonal Abx

Ceftazidime or Piperacillin + Fluoroquinolones or Aminoglycoside

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32
Q

Allergic rhinitis is associated with ____ ____ and tends to be worse in the (morning/afternoon/evening)

A

nasal polyps

morning

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33
Q

What may a patient’s ear with otitis externa look like on physical exam?

What will there be pain with?

A

PAIN ON TRACTION OF THE EAR CANAL/TRAGUS

external auditory canal erythema/edema/debris

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34
Q

How do you treat a patient with orbital cellulitis?

A

IV antibiotics: Vancomycin, Clindamycin, Cefotaxime, Ampicillin/sulbactam

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35
Q

What is the most common bacterial cause of acute pharyngitis/tonsilitis?

A

GABHS (strep pyogenes)

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36
Q

What is the recommended tx of viral conjunctivitis?

A

Supportive (cool compresses, artificial tears)

+/- antihistamines

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37
Q

What sx do patients with AOM typically present with?

Infants?

If TM perforates?

A

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)

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38
Q

What is the most common viral cause of infectious rhinitis?

Less common bacterial causes?

A

Rhinovirus (the common cold)

GABHS and Strep

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39
Q

SeptaI hematoma is associated with loss of _____ if the hematoma is not removed

A

cartilage

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40
Q

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?

A

Usually secondary to sinus infections (ethmoid 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
Q

What is the most common cause of viral conjunctivitis?

What is the most common source?

A

Adenovirus

Swimming pools

42
Q

Is viral or bacterial the more common cause of acute pharyngitis/tonsilitis?

A

Viral

43
Q

What is mastoiditis usually a complication of?

Do all patients with AOM have some degree of mastoiditis? Why/Why not?

A

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
Q

What infectious agent is most commonly responsible for viral conjunctivitis?

A

Adenovirus

45
Q

What are clinical manifestations of otitis externa?

History of?

Is hearing compromised?

A

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
Q

What is the recommended course of tx for acute pharyngitis/tonsilitis?

A

Symptomatic: fluids, warm saline gargles, topical anesthetics, lozenges, NSAIDs

Abx if S. pyogenes: Penicillin, Amoxicillin

PCN allergy: Erythromycin or Clindamycin

47
Q

What sx accompany acute pharyngitis/tonsilitis?

A

Sore throat, pain or swallowing or w/ phonation

Other sx based on the etiology

48
Q

What are possible etiologies of sensorineural hearing loss?

What is the most common cause of sensorineural hearing loss?

A

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
Q

What is first line tx of epistaxis?

What therapies may be adjunct to the first line therapy?

A

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
Q

What is preseptal cellulitis?

How do you differentiate between preseptal and orbital cellulitis based on sx alone?

Tx?

A

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
Q

What are possible etiologies of conductive hearing loss?

What is the most common cause of conductive hearing loss?

A

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
Q

What view of radiograph will be used to observe epiglottitis?

What will be seen?

A

Lateral cervical radiograph

Thumb/Thumbprint sign

53
Q

What is the tx of choice for a patient with oral candidiasis/thrush?

A

Nystatin liquid

Clotrimazole troches, oral fluconazole

54
Q

How do you dx a pt with strep throat?

What is the gold standard?

A

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
Q

What is 1st line tx for streptococcal pharyngitis?

A

PCN G or PCN VK 1st line

(Amoxicillin, Augmentin)

Macrolides if PCN allergic

56
Q

What is the most common age group for epiglottitis?

Male or female more common?

A

3 months-6 years

male 2x as common as females

57
Q

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?

A

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
Q

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?

A

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
Q

What infectious agent is the most common cause of PTA?

A

GABHS (strep pyogenes)

staph aureus, polymicrobial

60
Q

If there is sensorineural hearing loss (inner ear), what is the Weber test result?

Rinne test?

A

Weber: Lateralizes to NORMAL ear

Rinne: Normal AC>BC

Patient will have difficulty hearing their own voice and deciphering words

(sensoriNeural lateralizes to Normal ear + Normal Rinne)

61
Q

If there is conductive hearing loss (external/middle ear), what is the Weber test result?

Rinne test?

A

Weber: Lateralizes to AFFECTED ear

Rinne: (-) BC>AC

62
Q

Upon PE of a patient with allergic rhinitis, what would be observed?

A

PALE/VIOLACEOUS, BOGGY TURBINATES, nasal polyps with COBBLESTONE MUCOSA of the conjunctiva

63
Q

What is the way to definitively diagnose a patient with epiglottitis?

What will the epiglottitis look like?

A

Laryngoscopy

Cherry red with swelling

64
Q

What is another name for peritonsillar abscess?

A

Quinsy

65
Q

What is streptococcal pharyngitis caused by?

A

GABHS (aka strep pyogenes)

66
Q

How do you definitively dx a pt with orbital cellulitis?

A

High resolution CT scan: infection of the fat and ocular muscles

MRI

67
Q

What color turbinates are observed in viral rhinitis?

A

Erythematous

68
Q

Do patients with orbital cellulitis have normal visual acuity?

Pain?

What is proptosis?

A

DECREASED VISION

PAIN WITH OCULAR MOVEMENT

Proptosis (bulging eye)

eyelid erythema and edema

69
Q

In what type of rhinitis would intranasal corticosteroids be helpful in?

A

Allergic

70
Q

What is the tx for allergic conjunctivitis?

A
  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
Q

Tonsillitis –> ______ –> abscess formation

A

cellulitis

72
Q

Will patients with epiglottitis have inspiratory or expiratory stridor?

A

Inspiratory stridor

73
Q

What is the mainstay of tx for a pt with epiglottitis?

A

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
Q

Non Hib causes of epiglottitis are most commonly seen in what population?

A

adults, especially in pts who use crack cocaine

75
Q

What is the recommended course of tx of PTA?

A

Abx + aspiration or I&D

Tonsillectomy indications: recurrent strep infections, recurrent peritonsillar infections, chronic tonsillitis

76
Q

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?

A

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
Q

What is another name for neonatal conjunctivitis?

A

Ophthalmia neonatorum

78
Q

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?

A

PURULENT DISCHARGE, LID CRUSTING

Usually no visual changes (mild pain).

Absence of ciliary injection.

Fluorescein staining needed to detect corneal abrasions or keratitis.

79
Q

Why does AOM present more commonly in young children as opposed to adults?

What risk factors predispose one child versus another child to AOM?

A

Eustachian tube (ET) dysfunction (ET is wider, shorter & more horizontal)

Day care, pacifier/bottle use, parental smoking, not being breastfed

80
Q

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?

A

PREAURICULAR LYMPHADENOPATHY, copious watery discharge, scanty mucoid discharge.

Often bilateral

May have PUNCTATE STAINING on slit lamp examination

81
Q

What are potential complications of streptococcal pharyngitis?

Which complications are and are not precentable with abx?

A

Rheumatic fever (preventable w/ abx)

Glomerulonephritis (not preventable w/ abx)

Peritonsillar abscess

Cellulitis

82
Q

Patients with viral conjunctivitis often complain of a _____ _____ sensation in their eye, accompanied by physical exam findings of ____, and ____ vision.

A

foreign body

erythema

normal vision

83
Q

In what population is viral conjunctivitis most common?

Is viral conjunctivitis contagious?

A

Children

YES! highly contagious

84
Q

What is the cause of allergic rhinitis?

A

IgE mediated mast cell histamine release

85
Q

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 ____ ____

A

3-5 days

48 hours

rheumatic fever

86
Q

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?

A

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
Q

How to perfrom Weber test?

Rinne test?

Normal findings for each?

A

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
Q

What are some examples of viruses that can cause acute pharyngitis/tonsilitis?

A

Adenovirus, Rhinovirus, Enterovirus, Epstein-Barr virus, RSV, Influenza A & B, Herpes zoster virus

89
Q

What is TM perforation most commonly caused by?

Where does it most commonly occur on the membrane?

A

Due to penetrating/noise traumas

Most commonly occurs at the pars tensa

90
Q

What infectious organism most commonly causes bacterial conjunctivitis?

A

Staph aureus

Strep pneumoniae

H. influenza

91
Q

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?

A

Silver nitrate

gonococcal

chlamydia

HSV

92
Q

What is strabismus?

What is esotropia?

Exotropia?

Hypotropia?

Hypertropia?

A

Misalignment of the eyes

Esotropia: convergent strabismus, deviated inward (“crossed eyed”)

Exotropia: divergent strabismus, deviated outward

Down

Up

93
Q

Where does acute otitis media manifest?

What is it usually preceded by?

Rapid or gradual onset?

A

Infection of middle ear, temporal bone, and mastoid air cells

MC preceded by viral URI

Rapid

94
Q

What sx are typical in a pt with rhinitis?

A

Sneezing, nasal congestion/itching, clear rhinorrhea

Eyes, ears, nose, and throat may be involved

95
Q

What are other tx options for epistaxis?

A

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
Q

If Ophthalmia neonatorium is left untreated, what complications might ensue?

A

corneal ulceration, opacification, blindness

97
Q

What is the most common infectious organism that causes epiglottitis?

A

Hemophilus influenza type B (HiB)

98
Q

What are the three types of conjunctivitis?

A

Viral

Allergic

Bacterial

99
Q

What is the first line diagnostic test for mastoiditis?

A

CT scan

Rotation 1: Pediatrics (13 decks)

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