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EOR 3 - Peds > ENT/Pulm > Flashcards

ENT/Pulm Flashcards

1
Q

What used to be a common cause of neonatal conjunctivitis?

A

silver nitrate (now erythromycin used instead)

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2
Q

How can you tell difference b/w gonorrhea vs chlamydia conjunctivitis?

A 
G: onset: 2-5d of age 
copious purulent discharge 
C: onset: 4-19d of age 
hyperemia 
scant purulent discharge
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3
Q

What is the tx for gonorrhea conjunctivitis?

A

ceftriaxone

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4
Q

What is the tx for chlamydia conjunctivitis?

A

erythromycin (+ tx for gonorrhea (ceftriaxone))

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5
Q

What are the complications of gonorrhea conjunctivitis?

A

corneal perforation and scar threaten vision

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6
Q

What are the complications of chlamydia conjunctivitis?

A

pneumonitis

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7
Q

What is the most common cause of viral conjunctivitis?

A

adenovirus
swimming pools are the MC source

viral is MC in children

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8
Q

What is the MC cause of bacterial conjunctivitis?

A

S. pneumo, S. aureus

M. Catarrhalis

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9
Q

How does viral conjunctivitis present?

A

bilateral infection with watery drainage
may have viral prodrome
morning crusting is common (but less pronounced than bacterial)

self limited infection (10-21days)

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10
Q

How does bacterial conjunctivitis present?

A

unilateral, 2nd eye will follow in 24-48hours

purulent discharge and significant eye crusting

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11
Q

What is the tx for viral conjunctivitis?

A

artificial tears, topical antihistamines

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12
Q

What is the tx for allergic conjunctivitis?

A

topical antihistamines: olopatadine, pheniramine/naphazoline
Topical NSAIDs - ketorolac
Topical corticosteroids

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13
Q

What is the tx for bacterial conjunctivitis?

A

TMP/polymixinB drops during the day, erythromycin ointment at night

if contact lens wearer, cover for pseudomonas with floroquinolone or aminoglcoside

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14
Q

Orbital Cellulitis

A

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

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15
Q

How does orbital cellulitis present?

A

proptosis, edema, erythema
ophthalmoplegia (pain with eye movement)
HA, fever, malaise
Decreased vision

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16
Q

How is orbital cellulitis dx?

A

CT scan

MRI

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17
Q

What is the treatment for orbital cellulitis?

A

Hospital admission and IV ABX (clindamycin, vancomycin)

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18
Q

What is strabismus?

A

misalignment of the eyes (stable ocular alignment is not present until 2-3 months) –> normal alignment by 4 months of age

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19
Q

Esotropia

A

deviation inwards (strabismus)

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20
Q

Exotropia

A

deviation outward (strabismus)

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21
Q

How is strabismus dx?

A

corneal light reflex test
cover-uncover test
convergence test

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22
Q

What is the treatment for strabismus?

A

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)

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23
Q

Tympanic membrane infection

A

otitis media

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24
Q

How does otitis media present?

A 
preceded by viral URI commonly 
ear pulling doesnt increase pain 
loss of light reflex 
fever, otaliga, ear pulling 
CHL
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25
Q

How is OM dx?

A

GOLD standard = pneumatic otoscopy (or tympanogram)

26
Q

How and when do you tx OM?

A

ALWAYS tx <6mo
almost always tx 6mo - 2yo (unless unilateral?)

tx: Amoxicillin (80 - 90 mg/kg/day)
augmentin if persistent or recurrent

27
Q

Swimmers ear

A

otitis externa

MC caused by psuedomonas

digital trauma: staph aureus

28
Q

What is malignant otitis externa?

A

osteomyelitis at skull base secondary to pseudomonas –> MC in DM or immunocompromised pts

tx: ceftrazidime or piperacillin + floroquinolone or aminoglycoside

29
Q

What is the treatment for otitis externa?

A

ciprofloaxacin + dexamethasone

30
Q

What is the tx for OE with perforation?

A

ofloxacin

31
Q

How does mastoiditis present?

A

looks like acute OM + swelling @ mastoid
anteriorly rotated ear
fever, mastoid tenderness

32
Q

What is the treatment for mastoiditis?

A

CT scan

33
Q

What is the treatment for mastoiditis?

A

hospital admission
IV ceftraixone
possible surgical decompression

34
Q

How is TM perforation dx?

A

clinical dx - otoscope

Weber lateralized to the affected ear in connective hearing loss

35
Q

When is the earliest that one might see allergic rhinitis?

A

10-12 months a the earliest

36
Q

What is the treatment for allergic rhinitis?

A

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)

37
Q

What is the treatment for bacterial sinusitis?

A

amoxicillin

used only if sxs have been present for >10 days

38
Q

What are the different types of antihistamines?

A

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)
39
Q

Who gets thrush?

A

infants, neonates, immunocompromised

pts on ABX and steroids

40
Q

What is the tx for thrush?

A

Nystatin

41
Q

What is the most common cause of peritonsillar abscess?

A

S. pyogenes (group A strep)
S. aureus

post URI unilateral abscess formation in the soft tissue of the deep neck

tonsillitis –> cellulitis –> abscess formation

42
Q

Hot potato voice

A

PTA

43
Q

What is the gold standard for dx PTA?

A

needle aspiration

neck CT with IV contrast

44
Q

What is the treatment for PTA?

A

emergency referral to ENT
surgical I&D
post-op ABX: ampicillin-sulbactam IV
then augmentin x 14 days

45
Q

What causes retropharyngeal abscess?

A

S. aureus and S. pyogenes

46
Q

Who gets retropharyngeal abscesses?

A

<5 yo

47
Q

How does retropharyngeal abscess present?

A

odynophagia, stridor, drooling, torticollis

48
Q

How is retropharyngeal abscess tx?

A

hospitalization and consult with ENT

IV ABX: ampicillin-sulbactam or clindamycin

49
Q

What is the MC cause of pharyngitis?

A

50% are viral

50
Q

What bacterial pathogens cause pharyngitis?

A

group A beta hemolytic strep

51
Q

What is the classic presentation of pharyngitis?

A

sore throat, fever, HA, malaise, N
Sandpaper rash - starts on neck or trunk - then spreads to extremities

NO rhinorrhea or cough

52
Q

Scarlet fever

A

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

53
Q

Centor Criteria

A

determining whether or not to test for strep

age: 3-14yo 
absence of cough 
tonsillar exudates or swelling 
temperature >38C 
anterior cervical LAD
54
Q

RBC casts

A

glomerulonephritis - a complication of strep throat

55
Q

Jones criteria

A

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
56
Q

What is the tx for strep?

A

PCN or Amoxicillin x 10d

57
Q

What is the tx for strep if pt is allergic for PCN?

A

azithromycin, cefdinir x 5 days

58
Q

PANDAS

A

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

59
Q

What is the MC pathogen causing epiglottitis?

A

H. flu

involves soft tissue above vocal cords

60
Q

How is epiglottitis dx and tx?

A

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

EOR 3 - Peds (9 decks)

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