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Peds EOR > ENT/Ophthalmology > Flashcards

ENT/Ophthalmology Flashcards

1
Q

What is required for the clinical diagnosis of acute otitis media?

A

1) bulging of the tympanic membrane

2) other signs of acute inflammation (marked erythema of the tympanic membrane, fever, ear pain) and middle ear effusion

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2
Q

What are the most common bugs to cause acute otitis media?

A
  • S. pneumoniae
  • H. influenzae
  • M. catarrhalis
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3
Q

How long does acute otitis media last?

A

last less than 3 weeks

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4
Q

What is chronic otitis media?

A

> 3 months, 3 episodes in 6 months or 4 in 12 with clearing between
-clear serous fluid in the middle ear without symptoms of ear infection (may have hearing loss/asymptomatic) - no abx

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5
Q

How do you dx acute otitis media?

A

otoscopic - bulging, loss of landmarks, redness, TM injection
-a key finding is limited mobility of the TM with pneumotoscopy

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6
Q

What is the tx of acute otitis media?

A

-first-line amoxicillin, augmentin = 2nd line (PCN allergy = azithromycin, erythromycin, Bactrim)
-treat for <2 years for 10 days
and >2 years for 5-7 days

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7
Q

What are the complications of acute otitis media?

A

mastoiditis and bullous myringitis

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8
Q

What is the most common cause of viral acute pharyngotonsillitis?

A

adenovirus

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9
Q

What are the characteristics of mononucleosis?

A

Epstien Barr virus, fever, sore throat, lymphadenopathy, splenomegaly, atypical lymphocytes and heterophiles agglutination test (monospot)

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10
Q

When should you consider gonorrhea pharyngitis?

A

patients with recent sexual encounters or with non-resolving pharyngitis

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11
Q

When is it fungal pharyngotonsillitis?

A

in patients using inhaled steroids

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12
Q

What is strep pharyngitis caused by?

A

Group A B-hemolytic streptococci (GABHS)

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13
Q

What is the centor criteria?

A
  1. Absence of cough
  2. exudates
  3. fever (>100.4)
  4. cervical lymphadenopathy
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14
Q

What is not suggestive of strep?

A

coryza, hoarseness, and cough

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15
Q

What does the centor score need to meet to get a rapid streptococcal test?

A

3 out of 4 (sensitivity >90%)

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16
Q

What do you do if you have a negative rapid streptococcal test?

A

throat culture is the gold standard

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17
Q

What is the treatment for Group A Strep?

A

penicillin is first line, azithromycin if penicillin-allergic

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18
Q

What is the complications of Group A strep?

A

rheumatic fever and post-strep glomerulonephritis

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19
Q

What is the treatment of viral acute pharyngotonsillitis?

A

supportive

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20
Q

What is the treatment for mononucleosis?

A

symptomatic and avoid contact sports, antibiotics such as amoxicillin or ampicillin may cause a rash

  • for athletes planning to resume non-contact sports three weeks from symptoms onset
  • for strenuous contact sports 4 weeks after illness onset
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21
Q

What is the treatment for funga pharyngitis l?

A

clotrimazole, miconazole, or nystatin

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22
Q

What is the treatment of gonorrhea pharyngitis?

A

IM ceftriaxone and azithromycin

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23
Q

What are the symptoms of allergic rhinitis?

A

clear nasal drainage, rhinorrhea, itchy, watery eyes, sneezing nasal congestion, pale, bluish, boggy mucosa

  • allergic shiners (blue discoloration below eyes), transverse nasal crease
  • IgE mediated mast cell histamine release
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24
Q

What is the tx of allergic rhinitis?

A

avoid any known allergens and use antihistamines, cromolyn sodium, nasal or systemic corticosteroids, nasal saline drops or washes, and immunotherapy

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25
Q

Intranasal decongestants should not be used more then 3-5 days because it can cause what?

A

rhinitis medicamentosa

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26
Q

What is viral conjunctivitis?

A

acute onset unilateral or bilateral erythema o conjunctiva. copious watery discharge, tender preauricular lymphadenopathy, scant mucoid discharge

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27
Q

What is the MC of viral conjunctivitis?

A

adenovirus

-highly contagious

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28
Q

How is viral conjunctivitis transmitted?

A

direct contact or swimming pools

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29
Q

What is bacterial conjunctivitis?

A

will present with purulent (yellow) discharge from both eyes (“glued shut”), crusting, usually worse in the morning
-may be unilateral

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30
Q

What are the most common causes of bacterial conjunctivitis?

A

S. pneumonia and S. aureus

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31
Q

What are the signs and symptoms of M. catarrhalis and gonococcal?

A

copious purulent discharge, in a patient who is not responding to conventional treatment

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32
Q

What are the signs and symptoms of chlamydia (bacterial conjunctivitis)?

A

newborn, Giemsa stain - inclusion body, scant mucopurulent discharge

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33
Q

What are the signs and symptoms of allergic conjunctivitis?

A

red eyes, itching, and tearing, usually bilateral, cobblestone mucosa on the inner/upper eyelid

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34
Q

What is the tx of allergic conjunctivitis?

A

hand washing, avoid contamination

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35
Q

What is the treatment of bacterial conjunctivitis?

A
  • gentamicin/tobramycin
  • erythromycin ointment (chlamydia for newborns)
  • trimethoprim and polymyxin B
  • ciprofloxacin
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36
Q

What do you use for bacterial conjunctivitis with those that wear contact lenses?

A

pseudomonas treatment = fluoroquinolone (ciprofloxacin/ciloxan drops)

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37
Q

What is used for treatment of Neisseria conjunctivitis?

A

warrants prompt referral and topical + systemic antibiotics

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38
Q

What is the treatment for chlamydial conjunctivitis?

A

systemic tetracycline or erythromycin x 3 weeks, topical ointments as well, assess for STD or child abuse

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39
Q

What is the treatment for viral conjunctivitis?

A

eye lavage with normal saline BID 7-14 days, antihistamine drops, warm to cool compresses

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40
Q

What is the treatment for allergic conjunctivitis?

A

systemic antihistamines and topical antihistamines or mast cell stabilizers (Naphcon-A, Ocuhist, generics)

  • epinatine
  • azalastine
  • emedatine difumarate
  • levocabastine
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41
Q

What is epiglottis?

A

supraglottic inflammation and obstruction of airway due to infection with Haemophilus influenza type b (Hib)
-medical emergency

42
Q

Who does epiglottis usually occur to?

A

usually unvaccinated children or underserved area

43
Q

What are the signs and symptoms of epiglottis?

A

stridor, restlessness, cough, dyspnea, fever, dysphagia, drooling, respiratory distress (tripod/”sniffing dog” posture - neck extended)

44
Q

What are the 3 D’s of epiglottis?

A
  • dsyphagia
  • drooling
  • respiratory distress
45
Q

What is the dx of epiglottis?

A

secure airway then culture for H. flu

-the classic finding is thumbprint sign on x-ray lateral neck from swelling

46
Q

What is the tx of epiglottis?

A

intubating if necessary, supportive care, ceftriaxone, may treat as an outpatient if stable

47
Q

What are the causes of epistaxis?

A

nasal traume, dryness, hypertension, nasal cocaine, alcohol

48
Q

What is the most common site for anterior bleeds?

A

kiesselbach’s plexus or little’s are

49
Q

Where do posterior bleeds occur?

A

woodruff plexus (less frequent)

50
Q

What is the tx of epistaxis?

A
  • most nosebleeds are anterior and stop with direct pressure
  • apply direct pressure at least 10-15 minutes, seated leaning forward
  • short-acting topical decongestants (Afrin, phenylephrine, cocaine)
51
Q

What is involved in anterior nasal packing?

A

patients with nasal packing must be treated with antibiotics (cephalosporin) to prevent toxic shock syndrome and the patient has to return to take the packing out

  • if there is no packing in the nose, place a small amount of petroleum jelly or antibiotic ointment inside the nostril 2 times a day for 4-5 days
  • cauterize if able to visualize bleeding source
52
Q

What is used to treat posterior epistaxis?

A

posterior balloon packing
-high-risk for complications: specialist eval and inpatient monitoring; nasal arterial supply ligation via surgery in some cases

53
Q

What do you need to rule out when their are recurrent epistaxis?

A

hypertension of hyper coagulable disorder

54
Q

What can hearing loss be classified as?

A
  • conductive
  • sensorinerual
  • both (mixed loss)
55
Q

What is the weber test?

A

tuning fork is place on the center of the head to see if sound lateralizes - sound lateralizes to affected ear in conductive hearing loss, sound lateralizes to unaffected ear in sensorineural hearing loss

56
Q

What is the Rhinne test?

A

tuning fork placed on mastoid and then up to the ear (should continue to hear) conductive hearing loss if bone>air, sensorineural hearing loss if air>bone

57
Q

What are the findings for conductive loss?

A

Weber: hear in bad ear
Rhinne: bone>air

58
Q

What is the most common cause of otitis media?

A

conductive loss

59
Q

What are the findings of sensorineural loss?

A

Weber: hear in good ear
Rhinne: air >bone

60
Q

What is the most common cause of sensorineural hearing loss?

A

presbycusis

61
Q

What is prebycusis?

A

gradual, symmetric hearing loss associated with aging - the most common cause of diminished hearing in elderly patients - degeneration of sensory cells and nerve fibers at the base of the cochlea

62
Q

What causes sensorineural hearing loss

A

noise-induced, infection, drug-induced, congenital, meunière disease, CNS lesions

63
Q

What causes conductive hearing loss?

A
  • cerumen impaction, otitis externa, exostoses (bony outgrowths of external auditory canal related to exposure to cold water)
  • tympanic membrane perforation
  • otitis media, otosclerosis, neoplasms
64
Q

What is the treatment of hearing impairment?

A

treat the underlying cause, hearing aids, surgery, cochlear implants

65
Q

What is mastoiditis?

A

supportive infection of mastoid air cell - usually a complication of acute otitis media

66
Q

What is the organisms that that cause mastoiditis?

A

S. pneumonia, H. influenzas, M. catarrhalis, S. aureus, S. pyogenes

67
Q

How is mastoiditis dx?

A

clinical, CT scan temporal bone with contrast for complicated/toxic appearing

68
Q

What is the treatment of mastoiditis?

A

simple = oral antibiotics, IV antibiotics (ceftriaxone)

  • ENT referral in more serious cases or pt with unreliable follow up
  • drainage of middle ear fluid
69
Q

What is oral candidiasis?

A

oral thrush is an infection in which the fungus (candida albicans) accumulates in the mouth

70
Q

What are the signs and symptoms of oral candidiasis?

A

mouth pain and white plaques that bleed when scraped

71
Q

What is the dx of oral candidiasis?

A

KOH smear reveals budding yeast and psudohyphae

72
Q

What is the tx of oral candidiasis?

A

nystatin, oral fluconazole

73
Q

What is orbital cellulitis?

A

infection of orbital muscles and fat behind the eye (periorbital = infection only of skin)

74
Q

What are the signs and symptoms of orbital cellulitis?

A

decreased extraocular movement, pain with movement of the eye, and apoptosis, signs of infection

75
Q

What is orbital cellulitis often associated with?

A

sinusitis

76
Q

Who does orbital cellulitis most often occur in

A

children ages 7-12 y/o

77
Q

What is a rare manifestation of orbital cellulitis?

A

decreased vision

78
Q

How is orbital cellulitis dx?

A

Ct scan of orbits (confirmatory)

  • focused assessment on extra ocular muscles
  • CBC and blood cultures in some settings
79
Q

What is the tx of orbital cellulitis?

A

hospitalization and IV broad-spectrum antibiotics (vancomycin)

80
Q

What is bacterial otitis externl?

A

“swimmer’s ear”

-ear pain (especially with movement of tragus or auricle), pain with eating, purulent cheesy white discharge, palpation of tragus is painful

81
Q

What are the findings of tuning fork with bacterial otitis externl?

A

bone conduction > air conduction

82
Q

What is the most common cause of bacterial otitis externa?

A

Pseudomonoas aeruginosa (swimmer’s ear), S. aureus (digital trauma)

83
Q

Who is malignant otitis externa commonly seen in?

A

diabetics

84
Q

What is the tx for bacterial otitis externa?

A

antibiotic drops - (amino glycoside or fluoroquinolone +/- corticosteroids) + avoid moisture

85
Q

What is the tx for perforate or chance of perforation with bacterial otitis externa?

A

ciprofloxacin 0.3% and dexamethasone 0.1% suspension: 4 drops BID x 7 days or ofloxacin 0.3% solution 10 drops once a day x 7 days

86
Q

What is the tx for for bacterial otitis externa for a diabetic/immunocomprised patient?

A

necrotizing infection = hospitalization with IV abx (caused by aspergillus)

87
Q

What is fungal otitis externa?

A
  • pruitis, weeping, pain, hearing loss

- swollen, moist, wet appearance

88
Q

What are the causes of fungal otitis externa?

A
  • aspergillus niger (black)
  • A. flavus (yellow)
  • A. fumigates (gray)
  • Candida albicans
89
Q

What is the tx for fungal otitis externa?

A

topical therapy, anti-yeast for Candida or yeast: 2% acetic acid 3-4 drops QID, clotrimazole 1% solution, itraconazole oral

90
Q

What does peritonsillar abscess result from?

A

penetration of infection through tonsillar capsule and involvement of neighboring tissue

91
Q

What is the presentation of peritonsillar abscess?

A

presents with a hot potato (muffled) voice, severe sore throat, lateral uvula displacement, bulging tonsillar pillar

92
Q

What is the cause of peritonsillar abscess?

A

streptococcus pyogenes

93
Q

What is the tx of peritonsillar abscess?

A

aspiration, incision and drainage and/or antibiotics

-tonsillectomy may also be considered in about 10% of patients

94
Q

What antibiotics are used to tx peritonsillar abscess?

A

amoxicillin, amoxicillin-sulbactam, and clindamycin

-in less sever cases, oral antibiotics can be used for 7-10 days

95
Q

What is strabismus?

A

any form of ocular misalignment

96
Q

What is exotropia?

A

out-turning of eyes

97
Q

What is esotropia?

A

in-turning of eyes

98
Q

What is the dx of strabismus?

A 
the cover/uncover test 
-cover: cover one, observe other 
-(+) uncovered eye shifts to re-fixate
Cover/uncover 
-(+) deviated affected eye
99
Q

What is the tx of strabismus?

A

referral if constant anytime or intermittent >6 mo

-patch exercised, if untreated after age two, amblyopia results

100
Q

How does a tympanic membrane perforation present?

A

with pain, otorrhea, and hearing loss/reduction

101
Q

What can a tympanic membrane perforation occur from?

A

infection (acute otitis media) or trauma (barotrauma, direct impact, explosions)

102
Q

What is the tx of tympanic membrane perforation?

A

usually, resolve on own, surgical repair may be necessary with persistent hearing loss

  • keep dry - water/moisture to the ear should be avoided to prevent secondary infection that impedes closure
  • the only class of antibiotics that are non-ototoxic are the floxin drops and should be used if you are going to be prescribing drops with a perforated TM
  • surgery if persists past 2 months

Peds EOR (12 decks)

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