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Peds I > Exam 3: HEENT > Flashcards

Exam 3: HEENT Flashcards

1
Q

What is the etiology of bacterial conjunctivitis?

A

S. Pneumonia, H. Influenzae, M.Cat

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2
Q

What is the treatment for bacterial conjunctivitis?

A
  • erythromycin opthalmic ointment

- Trimethoprim-polymyxin B drops

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3
Q

What is the etiology of Neonatal conjunctivitis?

A

Chlamydia trachomatis

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4
Q

What type of conjunctivitis occurs in the first 5 to 14 days of life and has watery to mucopurulent to bloody discharge with chemosis and pseudomembrane?

A

Neonatal conjunctivitis

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5
Q

What is the gold standard for diagnosis of neonatal conjunctivitis?

A

NAAT- Nucleic Acid Amplification test

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6
Q

What is the treatment for neonatal conjunctivitis?

A
  • Oral erythromycin 50mg/kg per day divided in 4 doses for 14 days (based on positive diagnostic test)
  • Topical therapy is NOT effective
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7
Q

What is the etiology of hyperacute bacterial conjunctivitis?

A

Neisseria gonorrhoeae

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8
Q

What type of conjunctivitis occurs 2-5 days after birth, is rapidly progressive, has profuse and purulent discharge, and marked chemosis?

A

Hyperacute bacterial conjunctivitis

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9
Q

What are the complications of hyperacute bacterial conjunctivitis?

A
  • *SEVERE AND SIGHT THREATENING

- may have keratitis and perforation

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10
Q

What is the treatment for hyperacute bacteria conjunctivitis?

A
  • immediate ophthalmologist referral

- Hospitalization

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11
Q

What are contact lens wearers at bigger risk for?

A

Pseudomonas keratitis

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12
Q

What causes a foreign body sensation, blepharospasm, and corneal opacity?

A

Keratitis

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13
Q

What is the etiology of viral conjunctivitis?

A

Adenovirus

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14
Q

What type of conjunctivitis causes a burning, gritty sensation in the eye, watery and stringy discharge, and tender preauricular nodes?

A

Viral conjunctivitis

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15
Q

What is the management of viral conjunctivitis?

A

Symptomatic relief, warm/cool compresses, topical antihistamines, lubricant eye drops

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16
Q

What type of conjunctivitis causes bilateral injection, edema, and watery stringy discharge with ocular pruritis?

A

Allergic conjunctivitis

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17
Q

How is allergic conjunctivitis treated?

A

-topical vasoconstrictor + antihistamine for 2 weeks
(OTC Naphcon A, Visine A >6yrs old)
-antihistamine with mast-cell stabilizing properties (>3yrs old)
-DO NOT Prescribe topical glucocorticoids- ophthalmologist only

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18
Q

What is Kawasaki disease?

A

A mucocutaneous lymph node syndrome that causes small and medium sized vasculitis

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19
Q

What is the clinical presentation of Kawasaki disease?

A

CRASH

C-Conjunctivitis
R-Rash (morbilliform)
A-Adenopathy
S-Strawberry tongue
H- Hands are red, swollen, with subsequent desquamation
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20
Q

When should Kawasaki disease be considered?

A

In children with prolonged unexplained fever for more than 5 days

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21
Q

What are the complications of Kawasaki disease?

A

High risk of cardiovascular problems (coronary aneurisms, carditis, tachycardia, gallops, and muffled heart tones)

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22
Q

What is the treatment of Kawasaki disease?

A
  • Infectious disease and cardiology consult.
  • IVIG (provides extra antibodies and reduces the prevalence of carotid artery aneurisms)
  • high dose aspirin
  • Delay vaccines
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23
Q

What is dacryostenosis?

A

Nasolacrimal duct obstruction that results in chronic, intermittent tearing, mucous discharge, lash debris, and mild lower eyelid redness.

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24
Q

What is the etiology of dacryostenosis?

A

Congenital

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25
Q

What is the treatment for dacryostenosis?

A
  • Most resolve spontaneously by 6mo, but lacrimal sac massage is first line treatment
  • Ophthamology referral
  • Surgical probe
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26
Q

What is dacryocystitis?

A

Inflammation or infection of the lacrimal sac, often a complication of dacryostenosis

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27
Q

What is the etiology of dacryocystitis?

A

S. Epidermis and S. Aureus

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28
Q

What is the management of dacryocystitis?

A

-cultures
-prompt empiric treatment for 7-10 days
Mild: oral Clindamycin
Severe: IV vancomycin and 3rd generation cephalosporin
-ophthalmology referral

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29
Q

What is the etiology of AOM?

A

S. Pneumoniae, H. Flu, or M catarrhalis

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30
Q

A child presents with otalgia, fever, irritability, vomiting, and diarrhea. On exam, the child has a bulging TM with distorted landmarks, erythematous TM, and ottorrhea. What do you suspect?

A

Acute otitis media

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31
Q

What are the complications of AOM?

A

Perforation, hearing loss, cholesteatoma, facial nerve palsy, and mastoiditis

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32
Q

What must be present in order for AOM to be diagnosed?

A

1) bulging TM or other signs of inflammation (distinct erythema of TM, otalgia, and fever)

AND

2) Middle ear effusion (TM opacity, air fluid level, otorrhea)

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33
Q

What is the management of AOM?

A
  • Pain meds (Childrens acetaminophen/ibuprofen)
  • Abx (first line Amoxicillin 90mg/kg, second line augmentin)
  • 48-72 hr follow up
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34
Q

What antibiotics are recommended for AOM?

A

1) High dose amoxicillin 90 mg/kg/day divided q 12 hours (unless then have had recent B-lactams, recent AOM, or purulent conjunctivitis)
2) If any of the criteria from one, give Augmentin
3) If penicillin allergy, give Cefdinir, azithromycin, or Clindamycin

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35
Q

What prophylactic medications should be given during the winter months to someone with recurrent AOM?

And if that doesn’t work?

A

-Amoxicillin 40mg/kg/day OR Sulfisoxazole 50mg/kg/day

If those dont work, Myringotomy and tympanostomy tubes

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36
Q

Patient presents with amber (or gray/blue), cloudy, opaque, and retracted TM with positive air-fluid levels, decreased TM mobility, and hearing loss. What do you suspect?

A

Otitis media with effusion

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37
Q

What is the management of otitis media with effusion?

A
  • Symptomatic care

- Observation

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38
Q

What is the etiology Otitis Externa (swimmers ear)?

A

P. Aeruginosa
S. Aureus
S epidermis

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39
Q

A patient presents with otalgia, pruritis, discharge, hearing loss, tragus tenderness, and erythema/edema to the ear canal. What do you suspect?

A

Otitis externa

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40
Q

What is the management of otitis externa?

A
  • Thoroughly clean ear canal
  • Treat inflammation and infection (Floxin Otic solution, cortisporin otic suspension, ciprodex)
  • ear wick PRN
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41
Q

What education should be given to someone with otitis externa?

A

Avoid swimming and water exposure, dont put anything in ear, and no occlusive ear devices

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42
Q

What is the greatest risk factor for allergic rhinitis (aka allergic rhinosinusitis)?

A

Family history of atopy

43
Q

What is the pattern of symptoms for intermittent and persistent allergic rhinitis?

A

intermittent: <4/ week days OR <4 weeks
persistent: >4 days/ week AND >4 weeks

44
Q

What criteria must be met (1 or more) for a designation of moderate-severe allergic rhinitis?

A

Sleep disturbance
Impaired school performance
Impaired ADLs, leisure, sports
Troublesome symptoms

45
Q

What are the primary physical findings in a patient with allergic rhinitis?

A 
Allergic shiners
Dennie-Morgan lines
Allergic salute
Pale/ bluish, boggy nasal mucosa
Edematous turbinates
Cobblestoning on post. pharynx
46
Q

What are some things a patient may consider in regards to allergy avoidance in allergic rhinitis?

A

Dust mites, pets, close windows and doors, shower before bed

47
Q

What is the 1st line treatment for allergic rhinitis?

A

Intranasal steroids- fluticasone (flonase)

48
Q

Besides steroids (intranasal and oral), what else can be included in the pharmacotherapy of allergic rhinitis?

A

Antihistamines, decongestants, anticholinergics, mast cell stabilizers, LTR antagonists

49
Q

When is immunotherapy considered in the treatment of allergic rhinitis?

A

Patient has maximized environmental control measures and on optimal medication regimen

50
Q

How does the process of subcutaneous injection immunotherapy work?

A

Start with 1-2 sets of injections per week
Effective doses reached within 3-6 months
Visits every 2-4 weeks for remainder of treatment period

51
Q

What are nasal polyps and how are they commonly described?

A

Benign pedunculated tumors with a “pealed grape” appearance

52
Q

What other disease should be suspected in a child < 12 y/o with nasal polyps?

A

cystic fibrosis

53
Q

What is SAMTER’s triad?

A

nasal polyps, ASA sensitivity, asthma

54
Q

If a patient presents with obstruction of nasal passages, hypo-nasal speech/ mouth breathing, inflamed nasal mucosa, and profuse unilateral mucoid/ mucopurulent rhinorrhea, what should you be suspicious of?

A

nasal polyps

55
Q

How are nasal polyps treated?

A

Decongestants (symptomatic), intranasal steroid sprays, systemic steroids, surgery

56
Q

What is the most common etiology for a viral URI?

A

rhinoviruses

57
Q

Does a viral URI appear toxic or nontoxic?

A

Nontoxic

58
Q

What are the key physical findings of a viral URI in infants?

A

Fever and nasal discharge

59
Q

What are the key physical findings of a viral URI in school-aged children?

A

Nasal congestion, nasal discharge, cough

60
Q

What is included in the management of a viral URI?

A

Self limited, anticipatory guidance

61
Q

Would you prescribe abx for a viral URI?

A

NO- they do not shorten the course or prevent secondary complications

62
Q

What are the main complications of a viral URI?

A

Acute otitis media
Asthma exacerbation
Acute bilateral sinusitis

63
Q

What is the caution in using OTC decongestants?

A

Avoid using without direction
Do not use in children <6
Suggest avoidance in 6-12 y/o

64
Q

What are the key components of acute (bacterial) rhinosinusitis?

A

Persistent/ non-improving symptoms
Severe symptoms
Worsening symptoms- “double sickening”

65
Q

What are the key components of chronic rhinosinusitis?

A 
12+ weeks with 2+ of the following:
Ant/post drainage
Nasal obstruction
Facial pain/ pressure/ fullness
Decreased sense of smell
66
Q

How do diagnostic studies differ between acute and chronic rhinosinusitis?

A

Acute: +/- imaging, no culture, blood work or surgery
Chronic: imaging, +/- culture, blood work, surgery

67
Q

If you suspect bacterial acute sinusitis, what is the treatment?

A

Amoxicillin-clavulanate (Augmentin 45 mg/kg/day)

68
Q

What is included in the management of acute sinusitis?

A

Saline nasal irrigation
Decongestants
Antihistamines
Intranasal glucocorticoids

69
Q

What guidelines are unique to the treatment of only chronic sinusitis?

A

Control predisposing factors
Anti-leukotriene agents
Refer

70
Q

What is the most common etiology for pharyngitis?

A

Viral

71
Q

What are the primary symptoms of pharyngitis?

A

Sore throat and fever

72
Q

If a patient presents with sore throat, fever, rhinorrhea, nasal congestion, conjunctivitis, laryngitis, cough, wheezing, GI symptoms, and exanthema, what specifically would you be concerned about?

A

Vital pharyngitis

73
Q

What is included in the management of viral pharyngitis?

A

Supportive care and symptomatic relief

74
Q

What is the etiology for infectious mononucleosis?

A

Epstein-Barr virus (EBV)

75
Q

What are the classic symptoms/ physical findings of infectious mononucleosis?

A

Fatigue, tender cervical lymphadenopathy, palpable splenomegaly

76
Q

How is infectious mononucleosis diagnosed?

A

Heterophile antibody test (monospot- rapid serologic test)

77
Q

What is unique in the management of infectious mononucleosis?

A

Activity restriction for 4 weeks

78
Q

What is the most common cause of bacterial pharyngitis?

A

Group A strep (GAS)

79
Q

What is the likelihood of a + throat culture with a score of 6? 5?

A 
6= likelihood is ~85%
5= likelihood is 50%
80
Q

What are the classic symptoms/ physical findings of GAS pharyngitis?

A

Abrupt onset, exudate, palatal petechiae, tender cervical lymphadenopathy, scarlatinaform rash (diffuse “sandpaper” erythroderma)

81
Q

What criteria is widely used and an accepted clinical decision tool for GAS?

A

Centor criteria

82
Q

What is included as part of the Centor criteria?

A

Tonsilar exudates
Tender anterior cervical adenopathy
Fever by history
Absence of cough

83
Q

What does a score of <3 mean on the Centor criteria?

A

unlikely to have GAS (no testing, no abx)

84
Q

What does a score of 3+ mean on the Centor criteria?

A

perform RADT (rapid antigen detecting testing) for GAS

85
Q

If clinical suspicion is high with negative rapid strep, what should be ordered next?

A

Throat culture

86
Q

What is included in the management of GAS pharyngitis besides symptomatic relief?

A

Antibiotics in the first 48 hours- oral penicillin, amoxicillin, 1st ten cephalosporin, macrolide (azithromycin if pcn allergy)

87
Q

What are concerning complications of GAS pharyngitis?

A

Acute rheumatic fever (ARF)

Post-strep glomerulonephritis (PSGN)

88
Q

What are the 5 main manifestations of Acute rheumatic fever (ARF)

A
  1. Migratory arthritis
  2. Carditis
  3. CNS involvement
  4. Subcutaneous nodules
  5. Erythema marginatum
89
Q

What is the most common clinical presentation of Post-strep glomerulonephritis (PSGN)?

A

Edema, gross hematuria, HTN

90
Q

If in additional to abnormal urinalysis findings, you note depressed levels of C3 and CH50, and have a positive streptozyme test, what might you be concerned about?

A

Post-strep glomerulonephritis (PSGN)

91
Q

What is included in the management of Post-strep glomerulonephritis (PSGN)?

A

Supportive

Treat volume overload

92
Q

What criteria is used in deciding who gets their tonsils removed?

A

Paradise criteria for tonsillectomy

93
Q

What are the guidelines of the Paradise criteria for tonsillectomy?

A

At least 7 episodes in the last year OR
At least 5 episodes in each of the past 2 years OR
At least 3 episodes in each of the past 3 years

94
Q

What is considered an “episode” in the Paradise criteria for tonsillectomy?

A

ST + fever > 100.9 OR
Tonsilar exudate OR
Cervical adenopathy OR
Culture confirmed GABHS

95
Q

What is recommended by the Paradise criteria for tonsillectomy?

A

12 month observation period

96
Q

When does thrush commonly occur?

A

After antibiotic therapy

97
Q

What is the etiology of thrush?

A

Candida albicans

98
Q

If upon exam you note adherent white curd-like plaques, what might you be concerned about?

A

Thrush- “thrush will brush”

99
Q

What is included in the management of thrush?

A

Nystatin oral suspension

100
Q

What are mumps?

A

Highly contagious viral illness

101
Q

What develops within 48 hours of contracting mumps?

A

Parotitis

102
Q

What are a few of the complications of mumps?

A

Orchitis/ oophoritis

Neurological complications

103
Q

What is included in the treatment of mumps?

A 
Supportive care (acetaminophen, cold/ warm packs)
(No specific antiviral therapy)

Peds I (5 decks)

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