Exam 2 - Nose, Mouth, Throat & Neck Flashcards
Nasal airway DOUBLES in size by ______
6mo.
Never do a nasal exam in isolation - always accompany with full HEENT exam.
____ pairs of paranasal sinuses. They are not aerated at birth but slowly progress. What is the progression of sinus aeration?
4
Born with aerated ethmoids.
Maxillary between birth and 3-4mo
Sphenoid between 1-5 years
Frontal sinuses 7-adolescents.
What does CHARGE stand for and associated with?
Coloboma
Heart disease
Atresia/choanae
Retarded growth/development
Genital anomalies
Ear anomalies or deafness.
Syndrome for those who have mutation in CHD7 gene
What are some associated conditions with allergic rhinitis?
Conjunctivitis, sinusitis, OME, hypertrophic tonsils and adenoids and eczema.
3 fold increased risk of asthma.
Patients with allergic rhinitis have a 3-fold increase in risk for _____
Asthma
Allergic rhinitis is considered a
Major chronic respiratory disease of children because of high prevalence, effects on QOL, school performance and comorbidities.
Allergic rhinitis is usually a ________ diagnosis.
Clinical.
Allergic rhinitis is NOT common in kids ______
Under 2
Allergic rhinitis (AR) treatment
Avoid/limit exposure to allergens
Intra nasal corticosteroids (fluticasone, mometasone)
Oral antihistamines (Zyrtec, Claritin, Allegra)
Non responsive? Refer to immunotherapy.
You can start Flonase at what age?
2-4years old, however oral may be easier to administer if child is not able to sniff during Flonase administration.
With the common cold, fever usually resolves w/in______, sore throat in _____ and cough/nasal congestion w/in______
3-5days
7-9days
2 weeks
No cough or cold medicines in kids under ______
6yo.
Risk factors for Acute Bacterial Rinosinusitis (ABRS)
Recent URI, allergic rhinitis, cystic fibrosis, nasal polyps, immunodeficiency.
Acute vs chronic sinusitis
Acute <30days
Chronic >30 days.
What sinuses are most commonly affected by ABRS in younger pediatric patients?
Maxillary and ethmoid.
Common ABRS pathogens
Strep pneumonia, HIB, M cat.
Clinicians should make a presumptive diagnosis of ABRS when a child with a URI presents with one of the following:
Persistent symptoms >10 days without improvement (nasal discharge, cough)
Severe Symptoms
Fever (102.2 or >) and purulent nasal discharge > 3 days
Ill appearing
Worsening symptoms after initial improvement or “double sickening”
1st line tx for ABRS
Amoxicillin
However with high resistance, Augmentin is probably a better choice for 10 days.
(Start after 10 days)
Nosebleeds are rare in _______ and after ______
Infancy
Adolescents.
Watch closely for nasal infections such as furunkles, pimples, abscesses etc, because drains to
Cavernous sinus
Tx for Impetigo (microbe?)
Mupirocin (bactroban) ointment
Strep pyrogenes > staph.
Steroids are ________ in Herpes simplex gingivostomatitis
Contraindicated.
Tx for oral thrush
Nystatin oral suspension daily x7days.
Most common pathogen to cause pharyngitis?
Virus - rhinovirus.
What is most common bacterial cause of pharyngitis? Tx?
GA Strep.
penicillin 250-500mg/dose BID-TID x10 days
IM penicillin G x 1 dose
Oral amoxicillin
Allergic to beta lactate? Azithromycin
Strep pharyngitis is relatively uncommon in children _______
Under 3
Group A beta hemolytic strep is primarily seen in kids age __________
5-15
Treating early and for 10 days, we can prevent rheumatic fever, PTA, retropharyngeal abcess and cervical lymphadenitis but NOT ________1
Glomerular nephritis
Why might teens have an increased incidence of mumps?
They didn’t get their second MMR.
