ENT/Pulm Flashcards
What used to be a common cause of neonatal conjunctivitis?
silver nitrate (now erythromycin used instead)
How can you tell difference b/w gonorrhea vs chlamydia conjunctivitis?
G: onset: 2-5d of age copious purulent discharge C: onset: 4-19d of age hyperemia scant purulent discharge
What is the tx for gonorrhea conjunctivitis?
ceftriaxone
What is the tx for chlamydia conjunctivitis?
erythromycin (+ tx for gonorrhea (ceftriaxone))
What are the complications of gonorrhea conjunctivitis?
corneal perforation and scar threaten vision
What are the complications of chlamydia conjunctivitis?
pneumonitis
What is the most common cause of viral conjunctivitis?
adenovirus
swimming pools are the MC source
viral is MC in children
What is the MC cause of bacterial conjunctivitis?
S. pneumo, S. aureus
M. Catarrhalis
How does viral conjunctivitis present?
bilateral infection with watery drainage
may have viral prodrome
morning crusting is common (but less pronounced than bacterial)
self limited infection (10-21days)
How does bacterial conjunctivitis present?
unilateral, 2nd eye will follow in 24-48hours
purulent discharge and significant eye crusting
What is the tx for viral conjunctivitis?
artificial tears, topical antihistamines
What is the tx for allergic conjunctivitis?
topical antihistamines: olopatadine, pheniramine/naphazoline
Topical NSAIDs - ketorolac
Topical corticosteroids
What is the tx for bacterial conjunctivitis?
TMP/polymixinB drops during the day, erythromycin ointment at night
if contact lens wearer, cover for pseudomonas with floroquinolone or aminoglcoside
Orbital Cellulitis
extension of infectious sinusitis, dental, and trauma
MC association with ethmoid sinus infections
involvement of tissues posterior to the orbital septum
MC in children 7-12yo
How does orbital cellulitis present?
proptosis, edema, erythema
ophthalmoplegia (pain with eye movement)
HA, fever, malaise
Decreased vision
How is orbital cellulitis dx?
CT scan
MRI
What is the treatment for orbital cellulitis?
Hospital admission and IV ABX (clindamycin, vancomycin)
What is strabismus?
misalignment of the eyes (stable ocular alignment is not present until 2-3 months) –> normal alignment by 4 months of age
Esotropia
deviation inwards (strabismus)
Exotropia
deviation outward (strabismus)
How is strabismus dx?
corneal light reflex test
cover-uncover test
convergence test
What is the treatment for strabismus?
path therapy - normal eye is covered to strengthen the other eye
corrective surgery
if not treated before 2yo, amblyopia may occur (decrease visual acuity d/t cortical suppression of the vision of an eye)
Tympanic membrane infection
otitis media
How does otitis media present?
preceded by viral URI commonly ear pulling doesnt increase pain loss of light reflex fever, otaliga, ear pulling CHL
How is OM dx?
GOLD standard = pneumatic otoscopy (or tympanogram)
How and when do you tx OM?
ALWAYS tx <6mo
almost always tx 6mo - 2yo (unless unilateral?)
tx: Amoxicillin (80 - 90 mg/kg/day)
augmentin if persistent or recurrent
Swimmers ear
otitis externa
MC caused by psuedomonas
digital trauma: staph aureus
What is malignant otitis externa?
osteomyelitis at skull base secondary to pseudomonas –> MC in DM or immunocompromised pts
tx: ceftrazidime or piperacillin + floroquinolone or aminoglycoside
What is the treatment for otitis externa?
ciprofloaxacin + dexamethasone
What is the tx for OE with perforation?
ofloxacin
How does mastoiditis present?
looks like acute OM + swelling @ mastoid
anteriorly rotated ear
fever, mastoid tenderness
What is the treatment for mastoiditis?
CT scan
What is the treatment for mastoiditis?
hospital admission
IV ceftraixone
possible surgical decompression
How is TM perforation dx?
clinical dx - otoscope
Weber lateralized to the affected ear in connective hearing loss
When is the earliest that one might see allergic rhinitis?
10-12 months a the earliest
What is the treatment for allergic rhinitis?
loratidine (claritin)
fexofenadine (allegra)
desloratidine
cetirizine
fluticasone (intranasal steroids): best medication for congestions and post-nasal drip
Decongestants should NOT be used for >3-5 days d/t risk of rhinitis medicamentosa (rebound congestion)
What is the treatment for bacterial sinusitis?
amoxicillin
used only if sxs have been present for >10 days
What are the different types of antihistamines?
H2 inhibitors:
- Cimetidine (Tagamet)
- Ranitdine (Zantac)
- Famotidine (Pepcid)
H1 blockers (first gen):
- chlorpheniramine (chlortrimeton)
- diphenhydramine (benadryl)
- dimenhydrinate (dramamine)
H1 blockers (second gen):
- Loratadine (Claritin)
- Cetirizine (Zyrtec)
- Fexofenadine (Allegra)
Who gets thrush?
infants, neonates, immunocompromised
pts on ABX and steroids
What is the tx for thrush?
Nystatin
What is the most common cause of peritonsillar abscess?
S. pyogenes (group A strep)
S. aureus
post URI unilateral abscess formation in the soft tissue of the deep neck
tonsillitis –> cellulitis –> abscess formation
Hot potato voice
PTA
What is the gold standard for dx PTA?
needle aspiration
neck CT with IV contrast
What is the treatment for PTA?
emergency referral to ENT
surgical I&D
post-op ABX: ampicillin-sulbactam IV
then augmentin x 14 days
What causes retropharyngeal abscess?
S. aureus and S. pyogenes
Who gets retropharyngeal abscesses?
<5 yo
How does retropharyngeal abscess present?
odynophagia, stridor, drooling, torticollis
How is retropharyngeal abscess tx?
hospitalization and consult with ENT
IV ABX: ampicillin-sulbactam or clindamycin
What is the MC cause of pharyngitis?
50% are viral
What bacterial pathogens cause pharyngitis?
group A beta hemolytic strep
What is the classic presentation of pharyngitis?
sore throat, fever, HA, malaise, N
Sandpaper rash - starts on neck or trunk - then spreads to extremities
NO rhinorrhea or cough
Scarlet fever
sandpaper rash starting after 1-2 days after fever - starts on neck, then spreads to trunk and extremities
strawberry tongue (white then red)
Rash will last for 4-5 days
Centor Criteria
determining whether or not to test for strep
age: 3-14yo absence of cough tonsillar exudates or swelling temperature >38C anterior cervical LAD
RBC casts
glomerulonephritis - a complication of strep throat
Jones criteria
acute rheumatic fever
occurs 3-4 weeks after strep infection
Major:
- carditis
- polyarthritis
- chorea
- erythema marginatum
- subcutaenous nodules
Minor:
- clinical: fever, arthraliga
- lab: ESR, CRP, leukocytosis
What is the tx for strep?
PCN or Amoxicillin x 10d
What is the tx for strep if pt is allergic for PCN?
azithromycin, cefdinir x 5 days
PANDAS
pediatric autoimmune neuropsychiatric disorders associated with Strep infections
strep infection triggers a misdirected immune response –> resulting in inflammation in the brain
hallmarks: sudden onset of intense anxiety and mood lability accompanied by OCD-like issues and/or tics
What is the MC pathogen causing epiglottitis?
H. flu
involves soft tissue above vocal cords
How is epiglottitis dx and tx?
Thumb print sign on lateral neck Xray
definitive dx is made by direct inspection or cherry red and swollen epiglotisis –> observed when securing airway in the OR (intubation)
Augmentin
IV vanc + ceftriaxone x 7-10 days
