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Phase 2 PEDs > ENT/Resp basics > Flashcards

ENT/Resp basics Flashcards

1
Q

Ambylopia is?

A

Central vision loss due to bad development

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2
Q

Types of Ambylopia?

A

Strabismus
Refractory
Deprivation

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3
Q

Ambylopia due to Strabismus attributes?

A

Misalignment - brain ignores input from bad eye

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4
Q

Ambylopia due to Refractory attributes?

A

Vision blurry

  • Myopic - near-sighted
  • Hyperopic - far sighted
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5
Q

Ambylopia due to Deprivation attributes?

A

Vision obstructed

  • Retinopathy of prematurity
  • Congenital cataracts/glaucoma
  • Retinoblastoma (w/ leukocoria)
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6
Q

When is complete ophthalmologic exam is necessary?

A

Premature birth
Hx cerebral palsy/downs
Poor school performance

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7
Q

Reasons to refer to Ophthalmology?

A

Any - Nystagmus, Strabismus, Acuity >20/40 either eye after 3yo or 2 line difference on eye chart.
ABNL Red reflex
Torticollis that is unexplained

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8
Q

MC cause of conjunctivitis per timing of onset in neonate?

A 
Day
1-3 - Chemical
2-7 - Staph/Strep, Pseudomonas, E. Coli
3-21 - HSV
4-19 - C. Trachomatis
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9
Q

Types of conjunctivitis?

A

Neonatal
Infectious
Allergic
Chemical

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10
Q

Dx of HSV neonatal conjunctivitis?

A

Dendritic lesions on cornea

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11
Q

N. Gono infection Prevention?

A

Prph silver nitrate
OR
Erythromycin - Tetracycline ointment after birth

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12
Q

TXT of C. Trachomatis conjunctivitis?

A

(po) Erythromycin x14d

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13
Q

TXT of Gonorrhea conjunctivitis?

A

Ceftriaxone (IV) or (IM) once and ADMIT

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14
Q

TXT of HSV conjunctivitis?

A

Acyclovir + refer

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15
Q

TXT of S.A conjunctivitis?

A

(Top) Abx - Erythromycin or Polysporin

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16
Q

TXT of Pseudomonas conjunctivitis?

A

(Top) FQ - moxifloxacin or ciprofloxacin

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17
Q

Indications of viral conjunctivitis?

A

Pre-auricular node

Watery eye unilateral > bilateral

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18
Q

MC organism of viral conjunctivitis?

A

Adenovirus (Pink eye)

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19
Q

TXT of viral conjunctivitis?

A

Supportive/hand wash and cool compress

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20
Q

How to distinguish Bacterial from Viral conjunctivitis?

A

Bacterial - Purulent Discharge - Wipes frequently

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21
Q

TXT of HIB, S. Pneumo, M. Catarrhalis conjunctivitis?

A

(Top) Abx - Erythromycin, polymyxin, b-trimethoprim

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22
Q

What should be initial TXT of any conjunctivitis?

A

Gentle massage w/ warm moist washcloth

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23
Q

Polytrim ABX for conjunctivitis is? Form? Rx?

A

Ophth drops OF - Polymyxin B and Trimethoprim

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24
Q

Erythromycin for conjunctivitis is? Form?

A

Ointment

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25
Q

(PO erythromycin is used for what type of conjunctivitis?

A

C. trachomatis

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26
Q

Allergic conjunctivitis presents as?

A

Bilateral

  • Pruritus
  • Watery DC
  • Cobble-stoning eyelid edema
  • Blebs
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27
Q

TXT of allergic conjunctivitis?

A 
(Top) V-con, NSAIDs, AH
Blepharitisor
(Top) Cromolyn
or 
(PO) AH
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28
Q

How far does erythema/injection extend w/ conjunctivitis?

A

Stops before limbus

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29
Q

Blepharitis is?

A

Eyelid margin inflammation due to bacteria or dysfx of seborrhea/Meibomian glans

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30
Q

TXT of Blepharitis is?

A

Gentle cleanse (Johnson baby shampoo) and warm compress
OR
(Top) Abx - Bacitracin - Erythromycin

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31
Q

MC bacteria causing Blepharitis?

A

S.A.

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32
Q

Dacrocystitis is classified as?

A

Acute - complete block

Chronic - Partial blk (dacryostenosis)

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33
Q

Dacrocystitis is usually due to what organism?

A

S.A or coag = staph

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34
Q

TXT of Acute Dacrocystitis?

A

(PO) systemic Abx

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35
Q

TXT of Chronic Dacrocystitis?

A

Warm compress AND (Top) ABx

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36
Q

Complication of Dacrocystitis?

A

Orbital cellulitis

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37
Q

Hordeolum is?

A

External (Stye)- infected Zeis glands of eye lash follicle
Internal (Stye)- infected Meibomian gland
- Painful and RED

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38
Q

Hordeolum (Stye) MC organism?

A

Staph (TTP and RED)

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39
Q

TXT of Hordeolum?

A

Warm compress freq
NSAIDs
Refer - 1-2w if no resolution

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40
Q

Chalazion is?

A

Meibomian gland obstruction

- NOT painful or RED

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41
Q

Meibomian gland difference between Hordeolum and Chalazion?

A

Hordeolum - Internal stye = Infected Meibomian gland

Chalazion - Obstructed Meibomian gland

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42
Q

TXT of Chalazion?

A

SML - warm compress - SL wk-mo

No resolution or symptomatic - Refer CCS Inj or surgery

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43
Q

What is a serious complication of Sinusitis?

A

Orbital cellulitis

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44
Q

Orbital cellulitis is?

A

Bacteria spreading into orbit through infected sinus wall

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45
Q

Organisms ass/w Orbital cellulitis?

A

S.A, Strep pneumo, HIB

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46
Q

Which is a true emergency Orbital cellulitis or preseptal (periorbital) cellulitis?

A

Orbital cellulitis

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47
Q

TXT of Orbital cellulitis?

A 
Admit - Blood cx - CT (surgery)
IV Abx 
- Cefazolin OR Clindamycin
OR
- Cefuroxime + metronidazole
OR
- MRSA - Vanc + cefotaxime + clindamycin
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48
Q

RED flags of Orbital cellulitis?

A 
Fever
Painful extraocular motion
LROM of eyes
Exophthalmos
Vision changes
Chemosis
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49
Q

Complications of Orbital cellulitis?

A

Cavernous sinus thrombosis
Subperiosteal abscess
Vision loss

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50
Q

Preseptal (periorbital) cellulitis MC occurs in what pop?

A

<3yo

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51
Q

Which cellulitis of eye has pain/exophthalmos?

A

Orbital cellulitis - NOT preseptal cellulitis

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52
Q

Preseptal (periorbital) cellulitis is ass/w what MOI?

A

Skin lesion or trauma

53
Q

MC organism of Preseptal (periorbital) cellulitis?

A

S.A or GAS

54
Q

TXT of Preseptal (periorbital) cellulitis?

A

Outpt TXT w/ daily f/u

  • Augmentin or Cephalexin or Clindamycin
  • MRSA - TMP-SMX or Clindamycin
55
Q

Congenital anomalies ass/w AOM?

A

Cleft palate, Downs, HIV PEDs

56
Q

Pathogens MC to AOM

A

Bacteria - S. Pneumo, HIB, M. Catarrhalis, GAS

Viral - Rhinovirus, Influenza, RSV

57
Q

AOM Dx requires what 3 things?

A

Acute onset S?S
Mid Ear Effusion
Mid Ear Inflammation

58
Q

Other S/S of AOM?

A

Bulging TM - opaque or hyperemia
Decreased mobility of TM
TM air-fluid level

59
Q

Uncertain AOM can use what to help Dx?

A

Tympanometry - good seal/technique

60
Q

What is OME?

A

Effusion w/ otitis media - but w/out acute S/S

- common in 1st 2yr of life

61
Q

MC freq sequela of AOM?

A

OME

62
Q

TXT of AOM?

A

Abx
1L - Amoxicillin
2L - Augmentin
3L - Ceftriaxone (IM) - Cefdinir, Cefuroxime axetil

63
Q

AOM complications?

A 
Unresolved after months
Conductive hearing loss - Speech delay
Mastoiditis
Cholesteatoma
Petrositis
Intracranial invasion
64
Q

When is pressure equalization tubes considered for AOM?

A

PEDs w/ developmental risks
or
Recurrent AOM + 3mo persistent effusion w/ bilateral hearing loss.

65
Q

Mastoiditis S/S?

A

Posterior auricular TTP, edema, red + AOM

Pinna is displaced down/out

66
Q

Mastoiditis TXT?

A

Systemic Abx and ENT to I/D

67
Q

Cholesteatoma is?

A

Mass like keratinized epithelial growth

ENT refer

68
Q

Recurrent OM in <1mo requires?

A

Abx change

69
Q

Recurrent OM over >1mo requires?

A

Can use same Abx

70
Q

Prph Abx considered in Recurrent OM if?

A

> 3 episodes in 6mo
or
4 episodes in 12mo

71
Q

Prph Abx used for Recurrent OM?

A

Amoxicillin Q/d at night

Sulfisoxazole Q/d at night

72
Q

Indication for ENT referral concerning Recurrent OM?

A

Recurrence while on PRPH Abx
>3mo effusion
Speech/hearing delay
- >3 AOM episodes w/in 6mo OR >4 AOM episodes 12mo

73
Q

When are tympanostomy tubes inserted?

A

Recurrent OM
- >3 AOM epsiodes w/in 6mo
or
- >4 AOM episodes w/in 12mo

74
Q

Otitis Externa is AKA?

A

Swimmers Ear

75
Q

Otitis Externa is?

A

External auditory canal inflammation w/ exudate

76
Q

MC organisms ass/w Otitis Externa?

A 
P. aeruginosa - (ass/w swimming)
or
S.A.
or
Tubes - expands potential organisms
77
Q

Otitis Externa presents as?

A

Ear pain, TTP, discharge
Pinna/Tragus TTP (esp. if chewing)
Canal - red/edema
TM- usually NL

78
Q

Otitis Externa TXT?

A

(Top) - antimicrobial + CCS otic agent

  • Ofloxacin or Ciprofloxacin + Hydrocortisone or Dexamethasone
  • Polymyxin B - Hydrocortisone
79
Q

PVT of Otitis Externa?

A

Avoid vigorous cleaning of canal

Dry ears after swimming/showering - Acetic acid/diluted rubbing ETOH/ burrow solution

80
Q

MC attributes of Epistaxis?

A

6-10yo - Late fall or Winter

81
Q

Epistaxis pathology?

A

Dry friable mucosa at KIESSELBACH Plexus

82
Q

Epistaxis causes?

A 
MC - Digital trauma
URI/AR
FOB
Bleeding d/o
Dry air
83
Q

Initial TXT of Epistaxis?

A

Sit pt up - direct pressure pinching x10m

84
Q

Persistant Epistaxis w/ identifiable source TXT?

A

Cauterize w/ silver nitrate or aluminum chloride

85
Q

Persistant Epistaxis w/ NO source TXT?

A

Afrin spray
or
Afrin ointment soaked gauze, phenylephrine, lidocaine PACK!

86
Q

Severely persistant Epistaxis and all TXT failed?

A

Anterior nasal packing in place 2-3d
and
Prph Abx - Augmentin OR TMP-SMX

87
Q

When is ENT referral considered for Epistaxis?

A

Persistant bleeding or located posteriorly

88
Q

Complication of Epistaxis packing?

A

Septal necrosis

89
Q

PVT of Epistaxis?

A

Avoid trauma
Humidifer, Vaseline around nares
TXT underlying conditions

90
Q

Common Cold etiology?

A

MC - Rhinovirus

- Coronavirus > RSV > Flu > Paraflu > Adenovirus

91
Q

Common cold resolves when?

A

7-10d

92
Q

Complications of common cold?

A

OM or Bacterial sinusitis

93
Q

Common presents as?

A

Nasal congestion/rhinorrhea
Sore/Scratchy throat
+- non-productive cough

94
Q

TXT of common cold?

A

Symptomatic
Antipyretics - fever
NO - AH, decongestants <6yo Or NO Abx, cough suppressants and expectorants

95
Q

Sinuses present at birth?

A

Maxillary and Ethmoid

96
Q

When does other sinuses develop?

A

Sphenoid - 5yo

Frontal - 7yo > Adolescence

97
Q

What are ostia?

A

Narrow Openings 1-3mm that drain sinuses into middle meatus (AKA. Ostiomeatal complex)

98
Q

Are sinuses a sterile environment?

A

YES

99
Q

Sinusitis is?

A

Obstruction of mucociliary flow impeding drainage allowing for bacterial infection

100
Q

Pathogens ass/w acute Sinusitis?

A

S.A. - GAS - S. Pneumo
M. Catarrhalis
HIB

101
Q

Pathogens ass/w SUB-acute Sinusitis?

A

Anaerobes

102
Q

Common Sinusitis manifestations?

A

Lasts >10-14d w/out improvement
Mucopurulent rhinorrhea
Nasal stuffiness
Cough at night

103
Q

Other Sinusitis S/S possibly present?

A

Voice is nasal
Bad breath
Facial swelling/TTP
HA

104
Q

Most accurate Dx of Sinusitis?

A

Sinus aspiration - not necessary usually

- CT/MRI

105
Q

TXT of Sinusitis?

A

1L - Augmentin 14d

  • high dose therapy if -
    1. had ABX last 3mo
    2. <2yo,
    3. resistant patterns in area

2L - Levofloxacin (Type 1 HSN rxn to PCN)
or
2L - Clindamycin + Cefixime or Cefpodoxime
(Non-type 1 HSN rxn to PCN)

106
Q

Allergic rhinitis is AKA?

A

Hay fever

107
Q

Allergic rhinitis S/S?

A

Sneeze
Itch
Nasal congestion/Drainage

108
Q

Types of Allergic rhinitis?

A

Seasonal - pollen
Perennial - Indoor allergens
Episodic - Only if exposed to that environment

109
Q

Allergic rhinitis is what type of rxn?

A

IgE mediated allergic response

110
Q

Allergic rhinitis pathophys occurs how?

A

Early phase
- Mast cells degranulate > histamine, PG, leukotrienes
Late phase (4-8h later)
- EOS, BASO, CD4, Mono, SEGs >
- Mediators released >
- Nasal inflammation and PLT activating factor

111
Q

Allergic rhinitis is ass/w what other conditions?

A

Atopic triad

  • Eczema
  • Asthma
  • Allergic rhinits
112
Q

Stand out findings w/ Allergic rhinitis?

A

Pruritis
Cobble stoning
Allergic shiners
Transverse nasal crease

113
Q

Rhinitis medicamentosa is?

A

Overuse of (top) nasal decongestants

114
Q

TXT of Allergic rhinits?

A
  1. (IN) CCS - Fluticasone or Mometasone
  2. (PO) AH - 1st gen (Benadryl/hydroxyzine)
    or (MC) - 2nd gen (Cetirizine, loratadine, fexofenadine)
  3. (Top) AH - Azelastine or Olopatadine
  4. Cromolyn or Neocromodil (QID dosing)
  5. (2-3L) Montelukast (Leukotriene Recep antag)
  6. Immunotherapy
115
Q

Most potent Rx TXT for any Rhinitis?

A

(IN) CCS - Fluticasone or Mometasone

116
Q

Decongestants used for Allergic rhinitis?

A

Pseudoephedrine or Phenylephrine

117
Q

Rx specifically for non-allergic rhinitis OR rhinits ass/w viral URI?

A

(Top) Ipratropium Bromide nasal spray

118
Q

Pharyngitis/Tonsillitis pathogens?

A

Viral - rhino, corona, adeno, HSV, flu, etc

Bacterial - GAS, Group C strep

119
Q

Pharyngitis/Tonsillitis presents as?

A

Prominent sore throat
Fever
No URI S/S

120
Q

Pharyngitis/Tonsillitis is uncommon in what population?

A

Before 2-3yo

121
Q

Centor criteria?

A

1pt each -

  1. No cough
  2. TTP/Swollen Anterior cervical LAD
  3. Fever
  4. Swollen or exudative Tonsils
  5. 3-14yo

Results

  • 1-3 - Rapid/Cx > Abx IF positive
  • 4-5 - Rapid/Cx > Start empiric Abx
122
Q

Gold standard for Strep Pharyngitis/Tonsillitis?

A

Strep Culture

123
Q

If mononucleosis is part of DDx include what in eval?

A

Monospot AND CBC

124
Q

TXT of Pharyngitis/Tonsillitis strep?

A

(PO) PCN V x10d
(IM) PCN G Benz once
- cephalexin, cefadroxil, clindamycin x10d - PCN allergy
- Erythromycin x10d -or- Azuthromycin x5d - B-Lactam allergy

125
Q

Why is Strep Pharyngitis/Tonsillitis TXT?

A 
Shortens illness 12-24h
PVTs complications (ENT, Acute RF)
126
Q

What is not PVT during TXT of Pharyngitis/Tonsillitis?

A

PSGN

127
Q

Local complications of Pharyngitis/Tonsillitis?

A

AOM, Sinusitis, Peritonsillar abscess

128
Q

Systemic complications of Pharyngitis/Tonsillitis?

A 
Toxic shock syndrome
Scarlet fever
PSGN
RF
- PANDAS - basal ganglia autoimmune inflammation causing OCD/tics (motor/vocal)

Phase 2 PEDs (23 decks)

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