Exam 3: HEENT Flashcards
1
Q
What is the etiology of bacterial conjunctivitis?
A
S. Pneumonia, H. Influenzae, M.Cat
2
Q
What is the treatment for bacterial conjunctivitis?
A
- erythromycin opthalmic ointment
- Trimethoprim-polymyxin B drops
3
Q
What is the etiology of Neonatal conjunctivitis?
A
Chlamydia trachomatis
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
5
Q
What is the gold standard for diagnosis of neonatal conjunctivitis?
A
NAAT- Nucleic Acid Amplification test
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
7
Q
What is the etiology of hyperacute bacterial conjunctivitis?
A
Neisseria gonorrhoeae
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
9
Q
What are the complications of hyperacute bacterial conjunctivitis?
A
- *SEVERE AND SIGHT THREATENING
- may have keratitis and perforation
10
Q
What is the treatment for hyperacute bacteria conjunctivitis?
A
- immediate ophthalmologist referral
- Hospitalization
11
Q
What are contact lens wearers at bigger risk for?
A
Pseudomonas keratitis
12
Q
What causes a foreign body sensation, blepharospasm, and corneal opacity?
A
Keratitis
13
Q
What is the etiology of viral conjunctivitis?
A
Adenovirus
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
15
Q
What is the management of viral conjunctivitis?
A
Symptomatic relief, warm/cool compresses, topical antihistamines, lubricant eye drops
16
Q
What type of conjunctivitis causes bilateral injection, edema, and watery stringy discharge with ocular pruritis?
A
Allergic conjunctivitis
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
18
Q
What is Kawasaki disease?
A
A mucocutaneous lymph node syndrome that causes small and medium sized vasculitis
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
20
Q
When should Kawasaki disease be considered?
A
In children with prolonged unexplained fever for more than 5 days
21
Q
What are the complications of Kawasaki disease?
A
High risk of cardiovascular problems (coronary aneurisms, carditis, tachycardia, gallops, and muffled heart tones)
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
23
Q
What is dacryostenosis?
A
Nasolacrimal duct obstruction that results in chronic, intermittent tearing, mucous discharge, lash debris, and mild lower eyelid redness.
24
Q
What is the etiology of dacryostenosis?
A
Congenital
25
What is the treatment for dacryostenosis?
- Most resolve spontaneously by 6mo, but lacrimal sac massage is first line treatment
- Ophthamology referral
- Surgical probe
26
What is dacryocystitis?
Inflammation or infection of the lacrimal sac, often a complication of dacryostenosis
27
What is the etiology of dacryocystitis?
S. Epidermis and S. Aureus
28
What is the management of dacryocystitis?
-cultures
-prompt empiric treatment for 7-10 days
Mild: oral Clindamycin
Severe: IV vancomycin and 3rd generation cephalosporin
-ophthalmology referral
29
What is the etiology of AOM?
S. Pneumoniae, H. Flu, or M catarrhalis
30
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?
Acute otitis media
31
What are the complications of AOM?
Perforation, hearing loss, cholesteatoma, facial nerve palsy, and mastoiditis
32
What must be present in order for AOM to be diagnosed?
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)
33
What is the management of AOM?
- Pain meds (Childrens acetaminophen/ibuprofen)
- Abx (first line Amoxicillin 90mg/kg, second line augmentin)
- 48-72 hr follow up
34
What antibiotics are recommended for AOM?
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
35
What prophylactic medications should be given during the winter months to someone with recurrent AOM?
And if that doesn’t work?
-Amoxicillin 40mg/kg/day OR Sulfisoxazole 50mg/kg/day
If those dont work, Myringotomy and tympanostomy tubes
36
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?
Otitis media with effusion
37
What is the management of otitis media with effusion?
- Symptomatic care
| - Observation
38
What is the etiology Otitis Externa (swimmers ear)?
P. Aeruginosa
S. Aureus
S epidermis
39
A patient presents with otalgia, pruritis, discharge, hearing loss, tragus tenderness, and erythema/edema to the ear canal. What do you suspect?
Otitis externa
40
What is the management of otitis externa?
- Thoroughly clean ear canal
- Treat inflammation and infection (Floxin Otic solution, cortisporin otic suspension, ciprodex)
- ear wick PRN
41
What education should be given to someone with otitis externa?
Avoid swimming and water exposure, dont put anything in ear, and no occlusive ear devices
42
What is the greatest risk factor for allergic rhinitis (aka allergic rhinosinusitis)?
Family history of atopy
43
What is the pattern of symptoms for intermittent and persistent allergic rhinitis?
intermittent: <4/ week days OR <4 weeks
persistent: >4 days/ week AND >4 weeks
44
What criteria must be met (1 or more) for a designation of moderate-severe allergic rhinitis?
Sleep disturbance
Impaired school performance
Impaired ADLs, leisure, sports
Troublesome symptoms
45
What are the primary physical findings in a patient with allergic rhinitis?
```
Allergic shiners
Dennie-Morgan lines
Allergic salute
Pale/ bluish, boggy nasal mucosa
Edematous turbinates
Cobblestoning on post. pharynx
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46
What are some things a patient may consider in regards to allergy avoidance in allergic rhinitis?
Dust mites, pets, close windows and doors, shower before bed
47
What is the 1st line treatment for allergic rhinitis?
Intranasal steroids- fluticasone (flonase)
48
Besides steroids (intranasal and oral), what else can be included in the pharmacotherapy of allergic rhinitis?
Antihistamines, decongestants, anticholinergics, mast cell stabilizers, LTR antagonists
49
When is immunotherapy considered in the treatment of allergic rhinitis?
Patient has maximized environmental control measures and on optimal medication regimen
50
How does the process of subcutaneous injection immunotherapy work?
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
What are nasal polyps and how are they commonly described?
Benign pedunculated tumors with a "pealed grape" appearance
52
What other disease should be suspected in a child < 12 y/o with nasal polyps?
cystic fibrosis
53
What is SAMTER's triad?
nasal polyps, ASA sensitivity, asthma
54
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?
nasal polyps
55
How are nasal polyps treated?
Decongestants (symptomatic), intranasal steroid sprays, systemic steroids, surgery
56
What is the most common etiology for a viral URI?
rhinoviruses
57
Does a viral URI appear toxic or nontoxic?
Nontoxic
58
What are the key physical findings of a viral URI in infants?
Fever and nasal discharge
59
What are the key physical findings of a viral URI in school-aged children?
Nasal congestion, nasal discharge, cough
60
What is included in the management of a viral URI?
Self limited, anticipatory guidance
61
Would you prescribe abx for a viral URI?
NO- they do not shorten the course or prevent secondary complications
62
What are the main complications of a viral URI?
Acute otitis media
Asthma exacerbation
Acute bilateral sinusitis
63
What is the caution in using OTC decongestants?
Avoid using without direction
Do not use in children <6
Suggest avoidance in 6-12 y/o
64
What are the key components of acute (bacterial) rhinosinusitis?
Persistent/ non-improving symptoms
Severe symptoms
Worsening symptoms- "double sickening"
65
What are the key components of chronic rhinosinusitis?
```
12+ weeks with 2+ of the following:
Ant/post drainage
Nasal obstruction
Facial pain/ pressure/ fullness
Decreased sense of smell
```
66
How do diagnostic studies differ between acute and chronic rhinosinusitis?
Acute: +/- imaging, no culture, blood work or surgery
Chronic: imaging, +/- culture, blood work, surgery
67
If you suspect bacterial acute sinusitis, what is the treatment?
Amoxicillin-clavulanate (Augmentin 45 mg/kg/day)
68
What is included in the management of acute sinusitis?
Saline nasal irrigation
Decongestants
Antihistamines
Intranasal glucocorticoids
69
What guidelines are unique to the treatment of only chronic sinusitis?
Control predisposing factors
Anti-leukotriene agents
Refer
70
What is the most common etiology for pharyngitis?
Viral
71
What are the primary symptoms of pharyngitis?
Sore throat and fever
72
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?
Vital pharyngitis
73
What is included in the management of viral pharyngitis?
Supportive care and symptomatic relief
74
What is the etiology for infectious mononucleosis?
Epstein-Barr virus (EBV)
75
What are the classic symptoms/ physical findings of infectious mononucleosis?
Fatigue, tender cervical lymphadenopathy, palpable splenomegaly
76
How is infectious mononucleosis diagnosed?
Heterophile antibody test (monospot- rapid serologic test)
77
What is unique in the management of infectious mononucleosis?
Activity restriction for 4 weeks
78
What is the most common cause of bacterial pharyngitis?
Group A strep (GAS)
79
What is the likelihood of a + throat culture with a score of 6? 5?
```
6= likelihood is ~85%
5= likelihood is 50%
```
80
What are the classic symptoms/ physical findings of GAS pharyngitis?
Abrupt onset, exudate, palatal petechiae, tender cervical lymphadenopathy, scarlatinaform rash (diffuse "sandpaper" erythroderma)
81
What criteria is widely used and an accepted clinical decision tool for GAS?
Centor criteria
82
What is included as part of the Centor criteria?
Tonsilar exudates
Tender anterior cervical adenopathy
Fever by history
Absence of cough
83
What does a score of <3 mean on the Centor criteria?
unlikely to have GAS (no testing, no abx)
84
What does a score of 3+ mean on the Centor criteria?
perform RADT (rapid antigen detecting testing) for GAS
85
If clinical suspicion is high with negative rapid strep, what should be ordered next?
Throat culture
86
What is included in the management of GAS pharyngitis besides symptomatic relief?
Antibiotics in the first 48 hours- oral penicillin, amoxicillin, 1st ten cephalosporin, macrolide (azithromycin if pcn allergy)
87
What are concerning complications of GAS pharyngitis?
Acute rheumatic fever (ARF)
| Post-strep glomerulonephritis (PSGN)
88
What are the 5 main manifestations of Acute rheumatic fever (ARF)
1. Migratory arthritis
2. Carditis
3. CNS involvement
4. Subcutaneous nodules
5. Erythema marginatum
89
What is the most common clinical presentation of Post-strep glomerulonephritis (PSGN)?
Edema, gross hematuria, HTN
90
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?
Post-strep glomerulonephritis (PSGN)
91
What is included in the management of Post-strep glomerulonephritis (PSGN)?
Supportive
| Treat volume overload
92
What criteria is used in deciding who gets their tonsils removed?
Paradise criteria for tonsillectomy
93
What are the guidelines of the Paradise criteria for tonsillectomy?
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
What is considered an "episode" in the Paradise criteria for tonsillectomy?
ST + fever > 100.9 OR
Tonsilar exudate OR
Cervical adenopathy OR
Culture confirmed GABHS
95
What is recommended by the Paradise criteria for tonsillectomy?
12 month observation period
96
When does thrush commonly occur?
After antibiotic therapy
97
What is the etiology of thrush?
Candida albicans
98
If upon exam you note adherent white curd-like plaques, what might you be concerned about?
Thrush- "thrush will brush"
99
What is included in the management of thrush?
Nystatin oral suspension
100
What are mumps?
Highly contagious viral illness
101
What develops within 48 hours of contracting mumps?
Parotitis
102
What are a few of the complications of mumps?
Orchitis/ oophoritis
| Neurological complications
103
What is included in the treatment of mumps?
```
Supportive care (acetaminophen, cold/ warm packs)
(No specific antiviral therapy)
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