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Pediatrics > HEENT 1 > Flashcards

HEENT 1 Flashcards

1
Q

meibomian gland dysfunction

A

bhepharitis

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2
Q

what causes blepharitis

A

staphylococcus

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3
Q

treatment of blepharitis

A

Depends on the cause… Local steroid and antibiotic ointment applied at night

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4
Q

what causes hordeolum

A

staph infection

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5
Q

this is painful. externally, located in the glands of Zeis. Internally it is located in the meibomian glands

A

Hordeolum

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6
Q

Obstruction/inflammation in a meibomian gland, lump seen over the tarsal plate. Tend not to hurt

A

chalazion

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7
Q

watery, discharging eyes in first few months of life, plus or minus conjunctival redness

A

nasolacrimal duct obstruction

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8
Q

what bug causes nasolacrimal duct obstruction

A

staph and strep

HOWEVER, this is usually just a blockage rather than infection

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9
Q

cause of viral conjunctivitis

A

adenovirus

coxackievirus and enterovirus

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10
Q

Findings: red, dry eye starts unilaterally and spreads. Watery discharge, tender preauricular lymph node. Can present with cold sxs

A

viral conjunctivitis

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11
Q

Findings: red eyes bilaterally, pruritis, muco-purulent discharge, no cold symptoms

A

bacterial conjunctivitis

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12
Q

what causes bacterial conjunctivitis

A

Staph aureus, (s pneumo, H influ)

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13
Q

treatment for bacterial conjunctivitis

A

Topical erythromicin, polymixin-bacitracin, sulfacetamide, fluoroquinolones

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14
Q

neonatal conjunctivitis that can lead to permanent eye damage if not treated immediately

A

Opthalmia neonatorum

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15
Q

Cause of opthalmia neonatorum

A

organisms from the birth canal- Chlamydia or gonorrhea (e coli, HSV)

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16
Q

treatment for opthalmia neonatorum

A

SYSTEMIC antibiotic

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17
Q

Would you do cultures for conjunctivitis?

A

No, usually self limiting and respond well to treatment. EXCEPT in neonates, culture for G/C

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18
Q

Findings: itchy, watery eyes B/L. No injection. Cobblestone papillae on tarsal conjunctiva. Often presents with lid edema, nasal congestion/sneezing

A

allergic conjunctivitis

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19
Q

A patient with allergic conjunctivitis complains of photophobia and reduced vision. What do you think? What do you do?

A

Think corneal involvement- VERNAL conjunctivitis. Refer to opthalmologist

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20
Q

You see eosinophils in a conjunctival scraping. What is your dx?

A

allergic conjunctivitis

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21
Q

therapy for allergic conjunctivitis

A

Topical solutions combining antihistamine and mast cell stabilizers (can be OTC)
Antihistamine plus vasoconstrictors- Naphcon A
Liquid tears, oculoluberants

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22
Q

inflammation of the cornea

A

keratitis

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23
Q

common cause of keratitis

A

viral- HSV, N gonorrhea, adenovirus

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24
Q

You see a branching, dendritic ulcer. What do you think?

A

Herpetic keratitis

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25
Q

treatment for herpetic keratitis

A

ocular acyclovir

refer to opthal

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26
Q

I am going to use ocular corticosteroids to treat keratitis. Am i smart? why or why not?

A

NO. Corticosteroids are contraindicated for they cause rapid progression and can lead to corneal perforation

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27
Q

two complications of keratitis

A

corneal scarring

iritis/deep keratitis (EMERGENCY)

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28
Q

how can i see corneal abrasions?

A

fluorescein exam

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29
Q

treatment for corneal abrasion

A

antibiotic drops

patching the affected eye

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30
Q

what is likely to infect a corneal abrasion?

A

staph

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31
Q

pt has RA, sjogren, SLE, or polyarteritis nodosa and presents with eye complaint. What are you worried about?

A

corneal ulcer

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32
Q

Blood in anterior chamber of eye (trauma, glaucoma, vascular abnormalities

A

Hyphema

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33
Q

treatment hyphema

A

Usually an emergency… refer to opthal. Must suspect abuse in a child

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34
Q

Increased IOP creating pain, damage to eye structures resulting in progressive vision loss

A

glaucoma

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35
Q

three infective reasons for cataracts

A

Intrauterine Rubella, CMV, congenital varicella

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36
Q

Pts eye exam revels leukocoria, strabismus, nystagmus, and poor fixation

A

cataract

37
Q

two metabolic resons for cataracts

A

diabetes, galactosemia

38
Q

decrease in the child’s vision that can happen even when there is no problem with the structure of the eye

A

amblyopia

39
Q

treatment of amblyopia

A

patch the good eye to make the other one get better

40
Q

three types of amblyopia

A

strabismic
deprivation
refractive

41
Q

any misalignment of the eye. Usually result of an abnormality of NM control of eye movement

A

strabismus

42
Q

four types of strabismus

A

esotropia, exotropia, hypotropia, hypertropia

43
Q

strabismus: cranial nerves that can be involved

A

III IV

44
Q

Oscillatory movement of eyes, may be horizontal, vertical or torsional/rotational

A

nystagmus

45
Q

common reasons for nystagmus in kids

A

Congenital: neuro dysfunction
Acquired: vestibular lesions/inflammation/infection

46
Q

Neovascularization of immature eye vasculature seen in preemies

A

Retinopathy of prematurity

47
Q

ROP can result in

A

retinal detachment and vision loss

48
Q

most common cause of otitis externa

A 
pseudomonas aeuruginosa 
(staph aureus)
49
Q

treatment for otitis externa

A

Topical –2% acetic acid to restore ph …. Or antibiotic / corticosteroid drops . Common to use fluroquins like Cipro

50
Q

Ear exam: TM is grey, air fluid levels present, bubbles, little to no movement of TM, TM retracted

A

Otitis media with effusion

51
Q

usually caused by a non-infectious fluid level behind the TM. no pain, no fever. Hearing loss, fullness of ear, vertigo (maybe)

A

OME

52
Q

contributing factors to OME

A

allergic rhinitis
tonsillar/adenoid hypertrophy
sinusitis
eustacian dysfunction

53
Q

Kid with tons of post nasal drainage and a URI complains of ear pain, fullness, popping sensation and decreased hearing

A

Eustacian dysfunction

54
Q

Kid comes in: poor feeding, fever, pain, crying, pulling on ear

A

AOM

55
Q

Otoscope reveals red, bulging TM, impaired visibility of landmarks, bullae, (red, white yellow)

A

AOM

56
Q

Triad of findings: AOM

A
  • Recent abrupt onset of illness (URI)
  • Signs/sxs middle ear inflammation (otalgia, crying, otorrhea, fever)
  • Otoscopic findings (evidence of effusion)
57
Q

common bacterial bugs for AOM

A

s pneumo, h influ, moraxella catarrhalis

58
Q

common viral etiologies for AOM

A

RSV, influenza, (rhinovirus, coronavirus, parainfluenza, adenovirus, enterovirus)

59
Q

Kid comes in less than 6 months. You diagnose with AOM. treatment?

A

antibacterial therapy

60
Q

1 year old comes in, you think he has AOM but arent sure bc its not severe. Treatment?

A

observation

61
Q

1.5 year old comes in. You diagnose with AOM. Treatment?

A

antibacterial therapy

62
Q

7 year old comes in. You think he has AOM but arent sure. Treatment?

A

Observation

63
Q

3 year old comes in. Has non-severe AOM. Treatment

A

Observation

64
Q

first line for AOM antibacterial therapy

A

Amoxicillin 90mg/kg/day for 10 days

65
Q

second line tx for AOM

A

Amoxicillin-clavulante 90mg/kg/day of amox component for 7-10 days

66
Q

second line treatment for AOM fails. Now what

A

Ceftriaxone 50mg/kg dose parenterally for 1-3 days

67
Q

Pt is allergic to amox.. what else can i use to tx AOM

A

Cefdinir, cefpodoxime, cefuroxime, azithromycin, or clarithromycin

68
Q

When would you consider using PE tubes?

A

Chronic OME with conductive hearing loss
Failed tx for recurrent AOM
(they dont prevent ear infections)

69
Q

is AOM usually viral or bacterial?

A

VIRAL

70
Q

most common organism for mastoiditis

A

Strep pneumo and strep pyogenes

71
Q

Pt comes in with postauricular pain, fever, displacement of pinna

A

mastoiditis

72
Q

complication of mastoiditis

A

meningitis

brain abscess

73
Q

Treatment for mastoiditis

A

Myringotomy to obtain culture. Hospitalization with IV ABX (ceftriaxone and nafcillin or clindamycin). If severe, corticalmastoidectomy

74
Q

Growing mass of epithelial tissue within middle ear and temporal bone

A

cholesteatoma

75
Q

complications of cholesteatoma

A

permanent hearing loss, abscess, (sever morbidity and mortality if untreated)

76
Q

treatment for cholesteatoma

A

surgical removal

77
Q

Most common cause of conductive hearing loss in children

A

OM

78
Q

this type of hearing loss is due to defect in cochlear receptor cells or auditory nerve (CN VIII). RFs include LBW, low APGAR, hypoxia, TORCH, kernicterus

A

sensorineural hearing loss

79
Q

Aquired SNHL can come from which infections

A

CMV, meningitis, syphillis, lyme disease

80
Q

Which drug can cause SNHL

A

gentamicin

81
Q

Are you concerned: Kid has no teeth at 10 months

A

NO (15 months is a concern)

82
Q

Are you concerned: teeth arent coming out in pairs

A

YES. we want mirror patterns

83
Q

Natal teeth, what are we worried about?

A

Often have no roots and can fall out, aspiration risk

84
Q

most common cause of gingivits and caries

A

strep viridians

85
Q

kid shows up with10+ small mouth ulcers on buccal mucosa, anterior pillars, inner lips, tongue, gingiva (not posterior pharynx). What do you think?

A

HSV

86
Q

Treatment for HSV

A

treat symptoms, if caught early could start oral acyclovir 20mg/kg QID x 5days (no corticosteroids)

87
Q

Kid shows up with ulcers in the mouth that looks like apthous ulcers, but he has a fever. what do you think?

A

HSV stomatitis

88
Q

what causes thrush?

A

candidia albicans

89
Q

Kid shows up refusing to feed, with white curd like plaques on inner cheeks that bled when they were scraped off

A

Thrush

Pediatrics (15 decks)

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