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Pediatric Clinical Medicine > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

hematoma (eruption)

A

swelling of clotted blood within gingiva (gums); most common during eruption of first molar

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2
Q

bacteria that causes dental caries

A

strep mutans

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3
Q

candidasis

A

caused by yeast; white curd-like plaques initially beginning on the buccal and/or labial mucosa and spreading to the tongue and finally to the lips

Tx: nystatin fir up to 4 wks (baby’s mouth, mom’s nips), clean bottle nipples/pacifiers (dishwasher), oral Diflucan for 7 days (if nystatin does not work)

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4
Q

herpangina

A

caused by cocksackie virus

Sx: children <6 y/o (usually <3), low grade fever, rhinorrhea, vesicular/ulcerative lesions on the buccal, pharyngeal and/or labial (inside lining of lips) mucosa

Tx: oral discomfort (Ibuprofen, KBX, OTC orabase); resolves in 3 days

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5
Q

herpetic gingivostomatitis

A

caused by herpes simplex virus 1 (HSV)

Sx: children < 8 y/o, usually very high fever (often lasting 7-10 days), vesicles and ulcers to pharyngeal, buccal and labial mucosa and most important: the gingival mucosa

Tx: oral acyclovir, oral discomfort (Ibuprofen, KBX), hydration
- lasts 7 days

Caution: eczema herpeticum, herpetic meningitis ro encephalitis

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6
Q

glossitis

A

benign condition on surface of child’s tongue

Tx: none

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7
Q

apthous ulcers

A

known as “canker sores”, common after minor oral mucosa trauma; resolve in 7-10 days

Tx: none (avoid irritation), OTC orabase/Zilactin

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8
Q

mucocele

A

fluid-filled cysts on the labial or buccal mucosa, which develop following trauma

Tx: none, remove if interferes with chewing

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9
Q

ankyloglossia

A

lingual frenulum is attached very close to the tip of the tongue - does not allow full mobility of the tongue

Tx: EMT referral for frenectomy

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10
Q

Epstein’s pearls

A

whitish marks on midline of hard palate

Tx: none, will resolve in few wks

Bohn’s nodules: nodules on gingival ridges and hard palate

Dental lamina cyst: cyst along mandibular and maxillary gingival ridges

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11
Q

“danger zone” for infection on face

A

triangle made of maxilla (upper jaw bone) to corners of eye

  • area drains to brain
  • admit for IV (systemic ABX) if infection in this area
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12
Q

red reflex - ddx for abnormal

A 
cataracts
refractor error
retinoblastoma
strabismus
OM
conjunctivitis
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13
Q

Hirschberg’s test (corneal light reflex) - ddx for abnormal

A 
strabismus
refractory error
glaucoma (congenital)
conjunctivitis (bacterial/allergy)
trauma
botulism
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14
Q

cover / uncover - ddx for abnormal

A 
amblyopia
strabismus
hemangioma (large eyelid)
neoplasm
refractive error
glaucoma (congenital)
cataract disorder
neglect
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15
Q

visual acuity - ddx for abnormal

A

vital sign of eye!

conjuntivitis
sinusitis
trauma (FB or corneal abrasion)
refractory error
uveitis
orbital cellulitis
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16
Q

following eye conditions = urgent ophthalmology consult or referral

A

congenital cataracts

corneal ulcer

periorbital cellulitis (danger triangle) - augmenten if reliable historian and EOM intact

orbital cellulitis (danger triangle) - IV ABX

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17
Q

strabismus - treatment

A

patch or cyclopegic drops in good eye

surgery if not corrected

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18
Q

amblyopia - treatment

A

correct underlying issue (strabismus, refractive error, neoplasm, hemangioma) before age 6

patch or cyclopegic drops in good eye

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19
Q

dacrynostenosis - treatment

A

blocked tear duct

massage inner canthus of eye several times/day - should resolve in 4-6 months

ABX eye drops if purulent

referral to ENT for probing at 6mo

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20
Q

hordeolum - treatment

A

infected gland on eyelid

warm compress
ABX eyedrops
resolve in 2-3 days

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21
Q

chalazion

A

chronic (hardened) hordeolum

steroid eye drops - ophthalmologist referral

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22
Q

antihistamine - rx and OTC eye drops

A

Rx: Patanol or Pataday
OTC: Naphcon and Ketotifen

Indication: allergic conjunctivitis

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23
Q

antibiotic eye drops - rx

A

Polytrim, Vigamox, Ocuflox

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24
Q

antibiotic ointment - for kids <1

A

erythromycin

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25
Q

herpetic conjunctivitis

A

HSV infection of eye

eyelid swelling, pain, photophobia, dendrite formation on cornea (see w/ fluorescein stain)

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26
Q

red flags in history and exam of the eye

A

eye pain
photophobia
trauma
vision loss (vital sign of eye)

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27
Q

red flag of eye trauma - ddx

A
  • corneal abrasion/ulcer
  • endopthalmitis
  • periorbital cellulitis
  • orbital cellulits
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28
Q

red flag of photophobia

A

herpetic conjunctivitis
uveitis
endopthalmitis

note:
conjunctivitis (minor)
blepharitis

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29
Q

red flags for eye pain

A 
herpetic conjunctivitis
uveitis
endopthalmitis
keratitis
orbital cellulitis
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30
Q

red flags for vision loss

A

trauma (FB, corneal abrasion)
uveitis
endopthalmitis
orbital cellulitis

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31
Q

allergic conjunctivitis (ss, exam, tx, ed)

A

ss: bilateral, chemosis, cobblestoning on palprebral conjunctiva
pe: other allergic findings (boggy nasal turbinates, stringy/clear mucous)
tx: antihistamine: Patanol, PAtaday
ed: avoid allergen, itching, touching eyes
rtc: pain, photophobia, worsening of sxs, vision loss

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32
Q

bacterial conjunctivitis (ss, exam, tx, ed)

A

ss: purulent d/c, sig. erythema, swelling of eye lid, w/o pain
- lack of allergic and viral sx

tx: ABX eye drop (Polytram), erythromycin (<1)
ed: hand washing key, tx both eyes if spreads, should resolve in 24 h, return to school 24 h
rtc: pain, photophobia, worsening of sxs, vision loss

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33
Q

viral conjunctivitis (ss, exam, tx, ed)

A

ss: current URI, erythema w/ or w/o watery d/c
tx: ABX eye drop (Polytram), erythromycin (<1) - self-limiting
ed: hand washing key, tx both eyes if spreads, any purulent d/c resolve in 24 h, return to school
rtc: pain, photophobia, worsening of sxs, vision loss

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34
Q

corneal abrasion

A

assess: very painful, contact lens wearer, small pupil - lack of response, seen w/ fluorescein stain and tangential lighting and slit lamp
manage: ABX (polytrim), RTC 1 day (resolve), no contacts 24 hrs

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35
Q

corneal ulcer

A

assess: very painful, contact lens wearer, seen w/ tangential lighting and slit lamp (possibly w/ fluorescein stain) (ulcerative/whitish)
manage: urgent ophthalmic referral

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36
Q

ocular trauma

A

rule out hyphema or open globe (total thickness of eye wall) injury (urgent referral)

hyphema: concern for glaucoma
trauma: concern for retinal detachment

Note: do not do fluorescein stain until r/o open globe

Note: always look for fractures or other signs of ocular trauma

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37
Q

peri-orbital cellulitis

A

cause: secondary to skin disruption (insect bite, scratch)
exam: erythematous, edematous, warm eyelids with a fever; often can see small trauma; normal EOM

manage: outpatient Augmentin w/ strict monitoring and RTO precautions since in danger triangle
- fever, worsens, confusion, inc. HR or RR, SOB, fainting, pale skin

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38
Q

orbital cellulitis

A

cause: spread from sinusitis (from orbital bone) or eye trauma
exam: erythematous, edematous, warm eyelids with a fever; chemises of conjunctiva, proptosis (eye pops out), abnormal EOM
manage: admit for CT scan and IV ABX

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39
Q

rhinitis: most common causes

A

viral rhinitis

allergic rhinitis (“hay fever”)

bacterial sinusitis

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40
Q

viral rhinitis (ss, tx)

A

ss: frequent rhinorrhea with periods of resolution (even brief); yellow-green nasal discharge common around days 3-4, 7-14 days

tx: supportive care
- nasal irrigation q few hrs
- honey for cough (not <1)
- humidifier

41
Q

allergic rhinitis (ss, tx)

A

clear, thin rhinorrhea, nasal congestion, sneezing, pruritus of eyes, nose, ears and palate; post-nasal drip causes cough and hoarseness
• PE: pale pink/bluish gray, swollen boggy nasal turbinates w/ clear, watery secretion; dark periorbital areas, swollen eyelids, conjunctival injection
• Sxs: more constant, seasonal, crease on bridge of nose (“nasal salute”)
• Often accompanied by other atopic diseases: asthma, eczema

tx: intranasal steroids or systemic antihistamine

42
Q

bacterial sinusitis

A

longer than 10 days (but < month), fever, purulent discharge worsening
- unlikely in children since have later sinus development

tx: Amox 80/90 mg/kg/day BID x 10 days
- supportive care

43
Q

why do we treat group A strep with ABX (even when many have in system)

A

to avoid complications of post-streptococcal glomerulonephritis or rheumatic fever

44
Q

treatment for GAS carrier

A

Augmentin/clindamycin – associated with GAS eradication
o Be clear that you are not treating illness today
o Have pt RTC in 2 weeks for GAS culture to see if eradication worked or to prove carrier status

45
Q

GAS - treatment

A

If score indicates tx:
PCN (including amoxicillin, ampicillin), cephalosporins, and macrolides for 10 days
- Stress the importance of completing the entire regimen
- patients can return to school once they complete 24 hours of treatment

46
Q

sore throat - ddx

A

viral pharyngitis, sinusitis, GAS pharyngitis / scarlet fever, GAS carrier status, mononucleosis, abscess

47
Q

rapid strep test - validity

A 
low sensitivity (30% false negatives) - treat and send for culture
 - only do rapid strep for score of 6!!
48
Q

peritonsillar abscess - sxs

A

sore throat, fever, difficulty swallowing, hot potato voice

deviated uvula, bulging soft palate

Note: emergent ENT (life threatening due to airway obstruction)

49
Q

retropharyngeal abscess

A

sore throat, fever, difficulty swallowing, stiff neck, lateral neck flexion

Note: emergent ENT (life threatening due to airway obstruction)

50
Q

obstructive sleep apnea (ss, risk factors, management)

A

ss:
- Habitual snoring
- Episodes of arrested breathing/choking during sleep
- Behavior/learning problems including ADHD
- Nocturnal enuresis (inability to control urine)

risk factors:

  • Adenotonsillar hypertrophy
  • Obesity (BMI>97%)
  • Family hx
  • Cranial facial malformations

manage:

  • sleep study (EEG and resp. effort) and ENT if pos.
  • directly to ENT
  • tonsillectomy/adenoidectomy
  • CPAP machine
51
Q

child with fever OR rhinorrhea OR conjunctivitis

A

ALWAYS look in ears!

52
Q

most common cause of conductive hearing loss in children

A

otitis media with effusion (unresolved)

- why so important to have pt f/u in 4 weeks (and until resolved or refer to ENT)

53
Q

acute otitis media - key history questions

A

breastfeeding
smoke exposure
family history
vaccines: Prevnar and Hib

54
Q

acute otitis media - treatment

A

ABX if needed
- f/u if no improve in 2-3 d - change ABX (resistance)

Watchful waiting

  • f/u if sx do not resolve in 2-3 days
  • safety net Rx (avoid 2nd appt.)

Everyone dx with AOM
- follow-up in 4 weeks to see if otitis medial w/ effusion resolved

55
Q

acute otitis media - rules for ABX treatment

A

fever (>102.2 F / 39 C) w/ otalgia

bilateral involvement 6-23 mo.

if sxs persist for 2-3 days after seen

56
Q

AOM - 4 week follow-up

A

checking for resolution of otitis media with effusion

  • can use light reflex (present if effusion gone)
  • can use pneumatic otoscope
  • can use tympanogram
57
Q

ddx for ear pain

A 
AOM
OM w/ effusion
mastoiditis
foreign body
otitis externa
58
Q

tympanogram

A

provides acoustic measurements of TM middle ear system using sound energy

correlates well with presence or absence of middle ear effusion

sharp peak = normal TM mobility (lack of effusion)

59
Q

Amoxicillin dosing

A

80-90 mg/kg/day divided BID

  • this is high dose Amox
  • max: 3g/day

Note: same dosing for Augmentin

60
Q

mastoiditis

A

emergent complication of AOM (mastoid air cells infected) – keep on Ddx
• Infection in facial area of concern for meningitis and brain abscess
• Emergent referral to ENT or admit if ill appearing in office

61
Q

AOM - most common bacteria

A

Streptococcus Pneumoniae: PEN (Amox)

Resistant Strep. Pneumo or other organisms: Augmentin

62
Q

antibiotics used for common HEENT pathologies

A

1st line: high dose Amoxicillin
- 80-90 mg/kg/day (BID) x 10 days

2nd line: Augmentin (high dose Amox w/ clavulanic acid)

  • if had AMOX in past 30 days
  • if resistant strain (beta-lactamase)

3rd line: cephalosporins (Rocephin, IM daily for 3 days)
- for PEN allergy (no urticaria or anaphylaxis)

4th line: macrolides (azithromycin)
- if hx of anaphylaxis or urticaria with PEN

63
Q

key vaccinations for HEENT issues in PEDS

A

Prevnar (pneumococcal conjugate vaccine (PCV)) - vaccine against strep pneumoniae

Hib: Haemophilus influenzae type b

64
Q

tonsilar grading

A 
1+ = just visible
4+ = touching
65
Q

What treatment does every draining ear get?

A

ear drops - ABX (anti-bacterial) and steroid (anti-inflammatory)

66
Q

pre-auricular pits - findings and tx

A

small hole in front of crus of helix - developmental anomaly

tx: nothing unless infected (then referral to ENT for surgical removal of sinus)

67
Q

auricular hematoma - findings and tx

A

fluid (blood) fills space in Y of anti-helix of ear; caused by trauma to pinna (wrestler’s ear)

tx: referral to ENT for draining and pressure dressing

68
Q

perichondritis - findings and tx

A

inflammation of cartilage of ear (often from peircings in cartilage)

tx: oral or IV ABX w/ good cartilage penetration

69
Q

otitis external - findings and tx

A

inflammation and exudation in external auditory canal in absence of other disorders (OM or mastoiditis)

  • pain, tenderness (w/ pinna mov’t and chewing), DRAINAGE
  • no fever or hearing loss
  • occurs in summer months (“swimmers ear”)
  • can be bacterial or fungal

tx: topical drops (ABX ro corticosteroid) for every draining ear
- anti-fungal drops if fungal infection

70
Q

granulomas - findings and tx

A

salmon-colored tissue in middle ear (defected skin cells filled w/ blood vessels)

tx: Cipro X (topical ABX and steroid drop)
- if granulation does not go away = ENT referral

71
Q

exostosis - findings and tx

A

benign bony growths (caused by cold water exposure) – hard and painful on palpation w/ probe (can be multiple)
- surfers/kayakers ear

Tx: nothing (surgical intervention if traps wax)

72
Q

osteomas - findings and tx

A

benign tumor that will continue growing – soft and non-painful on palpation w/ probe (single lesion, reddish)

Tx: refer to ENT for removal – can cause problems if touches TM or occludes canal impeding on epithelial migration

73
Q

tympanosclerosis - findings, tx, potential complications

A

findings: calcified mass (scar plaque), bright white w/ distinct edges, surrounded by normal TM on all borders, TM mobility intact
tx: nothing
comp: rule out cholesteatoma

74
Q

TM perforations - findings, tx, potential complications

A

findings: hole in TM, shiny middle ear mucosa visible through the perforation (liquid)
tx: spontaneous healing likely; use drops if draining; avoid swimming or altitude

comp: refer to ENT if:
- not healing in 2 weeks
- signs of infection
- vertiginous after injury (spinning sensation)

75
Q

TM retractions - findings, tx, potential complications

A

cause: Eustachian tube dysfunction and middle ear gases resorb
findings: TM retracts (visualize bony landmarks)
tx: ENT referral for possibly PE tubes to releve pressure

comp:
- pressure on ossicles (ear bones) and lead to bony erosion and conductive hearing loss
- hearing worsens suddenly (loss of connection b/t incus and stapes)
- can result in cholesteatoma

76
Q

cholesteatoma - findings, tx, potential complications

A

cause: trapped epithelium cannot properly migrate out of ear canal (inflammation present, drainage can occur from infected debris)
- primary and secondary (see retractions)
- congenital (no retractions)
- hearing loss slight to moderate
- located in antero-superior quad (light area where should be darkest)

findings: yellowish or whitish mass behind TM w/ or w/o retractions (does not follow rules for tympanosclerosis)
tx: immediate referral to ENT

comp:

  • pressure and enzymes cause erosion of bones involved in hearing
  • can grow into ear canal, facial nerve (paralysis), brain (life-threatening)
77
Q

TM perforations - documentation

A

important to document quadrant and percentage perforated so tracking of healing is possible
- refer to ENT if not healed in 2 weeks (or making progress)

78
Q

mastoiditis - clinical presentation

A

complication of OM - inflammation and destruction of mastoid air cells result in infection of bone (osteitis) and mastoid abscess formation

findings: in addition to OM signs…
- posterior auricular tenderness, swelling, erythema
- pinna is displaced downward and outward

79
Q

indications for ENT referral

A

Pre-auricular pit: only if infected
Auricular hemotoma: always
Granuloma: if not resolved by ear drops (steroid and ABX)
Osteoma: always for removal
TM perforations:
- If not healing in 2+ weeks
- If accompanied by spinning sensation or infection

TM retractions: always
Cholesteatoma: always (surgery)
Mastoiditis: always (danger triangle)

80
Q

children with expected hearing loss - risks and signs

A

Perform objective screens: newborn, 4, 5, 6, 8, 10, 12, 15, 18 (annually but q 6 mo if high risk)
- Typanometry performed in physicians office and helps to dx and manage OM w/ effusion

Know risks: family hx, in utero infection (CHARGE association), low birth weight, low APGAR scores, parent concern, bacterial meningitis, head trauma, syndrome with known association to SNHL or CHL, recurrent or persistent OM w/ effusion

Know signs: delayed speech and language development (extensive language by age 3-4 y/o), below par performance, poor behavior, inattention in school

81
Q

children with expected hearing loss - management

A

Refer for full developmental and speech and language evaluation (audiology and speech evaluation)

If audiology and speech evaluation abnormal, refer to otolaryngology, genetics, ENT, speech referral for diagnostic testing

Repeat auditory testing as necessary to monitor

82
Q

type of hearing old associated with otitis media w/ effusion

A

conductive hearing loss

83
Q

hearing loss treatments

A

CHL: surgical correction or getting rid of effusion → ENT

SNHL: hearing aides

Congenital/prelingual onset deafness (infants, young child): multichannel cochlear implants
- note: risk of pneumococcal meningitis (must be vaccinated with PCV13)

84
Q

cochlear implants - which vaccine must be given first

A

PCV13 - risk of pneumococcal meningitis

85
Q

early childhood caries (ECC)

A

1 chronic disease in children

caries (repaired or not) or missing teeth from caries in children < 6 y/o

86
Q

complications of herpetic gingivostomatits

A

herpetic whitlow: vesicular lesions spread to hands - looks bad, but no big deal

eczema herpeticum: admission for IV anti-viral drugs (disseminated HSV)

herpetic encephalitis or meningitis (child with HSV has seizure): ER or admit for lumbar puncture

Note: seizure could be from high fever

87
Q

fever - DDx (HEENT)

A 
herpetic gingivostomastitis
viral sinusitis
rhinosinusitis
GAS pharyngitis
bacterial sinusitis
acute otitis media
otitis conjunctivitis syndrome
peritonsilar or retropharyngeal abscess
peri oribital or orbital cellulits
88
Q

checking for dehydration - children

A 
wet diapers / urination
color of urine
tongue blade on buccal mucosa
cap refill
skin turgor
89
Q

tooth fractures - things to keep in mind

A

aspiration of tooth (CRX)
intrusion injury (vs. avulsion)
facial cellulitis can occur if infection gets into tooth root and spreads
- maxilla: danger triangle (admit for IV ABX)
- mandible: outpatient tx w. PEN

90
Q

what should you do if you suspect an intrusion injury or Class 4 fracture

A

send to dentist for DENTAL x-ray

91
Q

maxillary lip laceration - do you need IV ABX b/c danger triangle

A

no, due to high blood flow to lips / mouth

92
Q

acute uveitis

A

inflammation fo uvea (pigmented layer b/t retina and sclera.cornea) - includes iris, ciliary body, and choroid

  • associated with JIA
  • erythema, ciliary flush (redness around iris), irregular pupil, poor vision, photophobia, pain, hypopyon
93
Q

choanal atresia

A

bony or membranous septum b/t nose and pharynx

  • CHARGE association
  • can be unilateral or bilateral
  • most common congenital anomaly of nose

think of (along with viral rhinitis, bacterial sinusitis, and foreign body) w/ purulent d/c

94
Q

pt with swollen eyelid

A

must do EOM exam to rule out orbital cellulitis

95
Q

PCP role in retinopathy of premature infant

A

follow-up on ophthalmology recheck

document discussions about importance of continued follow-up ( every 1-2 weeks)

96
Q

purulent nasal discharge - Ddx

A

viral rhinitis (rhino-sinusitis)
bacterial sinusitis
foreign body
choanal atresia

97
Q

clinical sxs of AOM

A
  1. moderate to severe TM bulging OR
  2. new onset otorhea OR
  3. mild TM bulging + <48 hr ear pain/evidence of discomfort
98
Q

clinical manifestations of AOM

A

ear pain, strabismus, abnormal eye mov/t, diarrhea, hearing loss, fever w/o a source

99
Q

population at inc. risk of developing persistent middle ear effusion resulting in conductive hearing loss

A

children <2

special circumstances: cleft palate, down syndrome, sinus disease, allergies

Pediatric Clinical Medicine (4 decks)

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