General Pediatrics Flashcards
Cystic neck masses
In general need to be removed because can become infected or blood-filled after hemorrhage
Painless midline neck mass that moves with tongue protrusion; may increase in size with URI or inflammation
Thyroglossal duct cyst
** most common congenital cystic lesion **
Nontender, fluctuant mass in lateral anterior triangle, may have associated drainage or inflammation
Branchial cleft cyst
Soft, smooth, nontender, compressible mass in posterior triangle, +transilluminates
Lymphatic malformation (cystic hygroma)
Red or bluish soft mass of variable location, + changes with valsalva
Hemangioma
Neck mass just lateral to midline that may have associated stridor, cough, or hoarseness, + changes with valsalva
Laryngocele
Supraclavicular mass more noticeable with crying, straining or coughing, increases with valsalva
Cervical lung hernia
Suprahyoid, nontender, smooth, rubbery mass
Dermoid cyst
Midline mass associated with hypo or hyperthyroidism
Goiter
Cystic hygroma
Only lesion that consistently transilluminates
Noonan Syndrome
Down Syndrome
Turner Syndrome
But only need to send testing if other features
How many external hemangiomas necessitate search for internal hemangiomas?
> 5
Empiric ABX for lymphadenitis
Clindamycin
Augmentin
1st/2nd gen cephalosporin in younger children
What is the most common cause of conductive hearing loss
OME
Most common non-syndromic sensorineural hearing loss
connexin 26 gene defect (AR)
Fainting + Long QT + SNHL
Jervelle Lange-Nielsen (AR)
Retinitis pigmentosa + SNHL
Usher Syndrome (AR)
Glomerulonephritis + high frequency SNHL
Alport’s Syndome (AR)
Pigment defects, different colored eyes, white forelock, SNHL
Waardenburg
Goiter + SNHL +/- balance abnormalities
Pendrid Syndrome
SNHL + vertigo after trauma
perilymphatic fistula
Single best predictor of school success
speech/language skills
What type of hearing loss with newborn hearing screen identify
Moderate/severe hearing loss, not mild (<40dB)
Universal screening by ___ month, confirm by ___ months, receive early interventions by ___ months
Universal screening by 1 month, confirm by 3 months, receive early interventions by 6 months
Air conduction: abnormal
Bone conduction: normal
CHL
Air and Bone conduction abnormal
SNHL (w/i 10 dB of each other) and Mixed hearing loss (bone >10 dB better)
Normal peak compliance at 0 P, normal volume
Type A = normal
Flat tympanogram, normal volume
Type B, likely middle ear effusion
Flat tympanogram, low volume
Type B, likely cerumen impaction of probe against canal wall
Flat tympanogram, high volume
Type B, TM perf or tympanostomy tubes
Peak compliance at negative P, normal P
Type C, retracted TM (URI, Eustachian tube dysfunction)
What additional vaccines should children with cochlear implants receive
PPSV-23
Typical PCN resistance pattern for organisms causing AOM
S pneumoniae 40%
H influenzae 50%
M catarrhalis 99%
Recurrent AOM
> 3 episodes in 6 months or >4 in 1 year
AOM + PCN Allergy (urticaria or anaphylaxis)
Type 1 hypersensitivity
Macrolid (1st)
Trimethoprim/Sulfamethoxazole or Clindamycin (2nd)
AOM + PCN Allergy (non-type 1 hypersensitivity)
Cephalosporin
AOM + …
- Amox within last 30 days
- conjunctivitis (H flu)
- severe diesease on presentation
Rx: Augmentin
Percent of children with an effusion after 2 weeks of ABX for AOM
60-70%
Most common complication of AOM
TM perforation
Most common SERIOUS complication of AOM
Mastoiditis
Rx for bullous myringitis
Rx same as routine AOM
Indications for PE tubes
- recurrent AOM
- persistent OME associated with high-risk patient or hearing loss
What is the most common risk factor for acute bacterial sinusitis
Viral URI (allergic rhinitis #2)
Sinus development
Ethmoid/Maxillary: birth
5phenoid: 5 years
Frontal > 7 years –> adolescence (clinically significant around 10-11)
Gold standard for sinusitis diagnosis
Sinus aspiration
Sinus and nasopharyngeal cultures do not correlate
Pott puffy tumor
osteomyelitis frontal bone
Tympanogram with poor compliance and high volume
perforated TM
Tympanogram with poor compliance and low volume
Cerumen or against canal wall
Tympanogram with poor compliance, normal volume
Effusion or tympanosclerosis
Peak compliance at a negative pressure
Eustachian tube dysfunction, early AOM
Normal bone conduction, abnormal air conduction
CHL
Abnormal air and bone conduction
SNHL (mixed if difference between bone and air is >10dB)
