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Pediatrics > HEENT 1 > Flashcards

HEENT 1 Flashcards

1
Q

what is inflammation of the lid margins may be associated with conjunctivitis

A

blepharitis

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2
Q

what has symptoms of burning and irritated eyes, photophobia

A

blepharitis

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3
Q

what is caused by most often a staph infection, can be meibomian gland dysfunction, and seborrhea

A

blepharitis

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4
Q

how do you treat blepharitis?

A

Local steroid and antibiotic ointment applied at night (depending on cause). This may be needed long term as the condition tends to recur

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5
Q

what is a hordeolum?

A

Stye

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6
Q

what is a hordeolum caused by?

A

Staph infection
External - glands of Zeis in lid
Internal – meibomian glands , can lead to Chalazion

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7
Q

what is a painful and red bump on the eyelid?

A

hordeolum

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8
Q

how do you treat a hordeolum? 4

A

Often Self-limiting
Drainage
Warm compresses
Local antibiotics to prevent recurrence.

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9
Q

what is Obstruction / Inflammation in a Meibomian gland.

A

chalazion (meibomian cyst)

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10
Q

what may develop acute suppuration infection–> A lump is seen over the tarsal plate

A

chalazion

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11
Q

how do you treat a chalazion? acute and chronic?

A

If acutely inflamed , warm compresses and antibiotics to reduce cellulitis.
Chronic cysts – incise and curette.

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12
Q

what is Normal canalisation of the nasolacrimal ducts may nor occur until 4-6 months of age.

A

nasolacrimal duct obs

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13
Q

what may cause Tear overflow and secondary infection

A

nasolacrimal duct obs

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14
Q

what has clinical findings of watery, discharging eyes in first few months of life- can be mucoid
+/- conjunctival redness
Erythema of lids

A

nasolacrimal duct obs

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15
Q

when infection caused, what bug causes nasolacrimal duct obs

A

strep and staph

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16
Q

how do you tx nasolacrimal duct obs?

A

Massage over lacrimal sac
Local antibiotic drops – for secondary infection
Surgical treatment = probing . Successful 80% of the time
Most clear spontaneously in 1st year of life.

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17
Q

what is the most common cause of viral conjuctivitis?

A

adenovirus

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18
Q

what are 2 other less freq viruses that cause conjunctivitis?

A

coxackievirus and enteroviruses

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19
Q 
what presents with Frequently unilateral initially, spread to other eye 1-3 days later 
 Red eye, dryness/burning sensation
 Watery discharge
Tender preauricular lymph node
Can present with pharyngitis, cold sxs
A

viral conjunctivitis

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20
Q

how do you tx viral conjunctivitis

A

support

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21
Q

what lymph node may present tender in viral conjunctivitis

A

preauricular

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22
Q

what is the most common cause of bacterial conjunctivitis?

A

S.aureus

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23
Q

what is the 2nd most common cause of bacterial conjunctivitis?

A

S. pneumo

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24
Q

what is the 3rd most common cause of bacterial conjunctivitis?

A

h.flu

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25
Q

what kind of bacteria should you suspect in ppl who wear contacts in bacterial conjunctivitis?

A

N. gonn and pseudmonas

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26
Q

how do you treat bacterial conjunctivitis? 4

A

Topical erythromicin, polymixin-bacitracin, sulfacetamide, fluoroquinolones

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27
Q

what is opthalmia neonatorum? and what could it cause if untreated? what is it caused by?

A

Neonatal conj
could lead to permanent eye damage unless it is treated immediately (Erythromycin)
Organisms from birth canal = Chlamydia or gonorrhea ,E coli , HSV

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28
Q

in what conjunctivitis should you get gram stain and cultures?

A

neonates

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29
Q

what presents with Itchy eye, Rubbing of eyes
Watery discharge
No injection
Often lid edema, nasal congestion/sneezing present
Cobblestone papillae on tarsal conjunctiva

A

allergic conjunctivitis

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30
Q

in allergic conjunctivitis what does photophobia and reduced vision mean?

A

corneal involvement and possible serious loss of vision!

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31
Q

what has Eosinophils in conjunctival scraping

A

allergic conjunctivitis

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32
Q

how do you treat allergic conjunctivitis?

A

Topical solutions combining antihistamine and mast cell stabilizers,
Antihistamine plus vasoconstrictors- Naphcon A,

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33
Q

what is Inflammation of the cornea?

A

keratitis

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34
Q

what may cause keratitis

A

HSV, N gonn, Adenovirus

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35
Q

how do you treat herpetic keratosis

A

acular acyclovir

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36
Q

what can lead to corneal scarring

iritis and deep keratitis

A

recurrence of keratitis

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37
Q

what is contraindicated in keratitis

A

Corticosteroids are contraindicated for they cause rapid progression and can lead to corneal perforation

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38
Q

what is always the wrong answer for treatment in eyes

A

CORTICOSTERIODS

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39
Q

what causes a corneal abrasion?

A

Trauma or FB

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40
Q

what is corneal abrasion?

A

physical scratch over cornea

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41
Q

what has symptoms of pain, blurred vision, photophobia and may use fluorescein exam to reveal

A

corneal abrasion

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42
Q

how do you treat corneal abrasion

A

Abx gtts to avoid secondary infection (common)

Patching for comfort if sxs severe

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43
Q

what is related to rheumatologic dz (RA, sjogren, SLE, polyarteritis nodosa

A

corneal ulcer

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44
Q

how do you treat corneal ulcer

A

Tx underlying Dz, usually by rheumatology

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45
Q

what is Blood in anterior chamber

A

hyphema

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46
Q

when you see hyphema what should you think? 3

A

trauma, glaucoma, vascular abn

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47
Q

how do you treat hyphema?

A

Treatment underlying dz if applicable, pain mgmt.

may need surgery if no resolution

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48
Q

what is primary glaucoma?

A

present at birth

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49
Q

what is secondary glaucoma?

A

d/t genetic or other congenital syndromes, prenatal infection, etc

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50
Q

what is marked by Increased IOP creating pain, damage to eye structures resulting in progressive vision loss

A

glaucoma

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51
Q

how do you treat glaucoma?

A

Tx medical or surgical depending on severity, usually by ophtho
Can be medical emergency if acute presentation

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52
Q

what is opacity of the lens that may be bilateral or unilateral

A

catarct

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53
Q

what may be AD AR or xlinked?

A

cataract

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54
Q

what may be caused by Intrauterine Rubella, CMV, congenital varicella

A

cataract

55
Q

what has symptoms of Leukocoria, strabismus, nystagmus, poor fixation

A

cataract

56
Q

what has Altered red reflex on ophthalmoscopic examination.

A

cataract

57
Q

how do you treat cataract

A

surgical

58
Q

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

A

amblyopia

59
Q

what are the 3 types of amblyopia

A

Strabismic amblyopia,
deprivation amblyopia
refractive amblyopia

60
Q

how do you treat amblyopia

A

patch unaffected eye

61
Q

what is any misalignment of the eyes

A

strabismus

62
Q

what is esotropia, exotropia, hypotropia, and hypertropia

A

strabismus

63
Q

when strabismus involves cranial N what is it?

A

3rd nerve palsy, superior oblique palsy

64
Q

what is d/t an abnormality of the poorly understood neuromuscular (including brain) control of eye movement.

A

strabismus

65
Q

disorders that affect the brain such as cerebral palsy, Down syndrome, hydrocephalus and brain tumor are more likely to develop what eye condition?

A

strabismus

66
Q

how do you treat strabismus? 4

A

eye glasses, eye exercises, prism, and/ or eye muscle surgery

67
Q

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

A

nystagmus

68
Q

what are 4 congenital causes of nystagmus

A

Idiopathic
Neurologic dysfunction
Decreased visual acuity
Rarely glioma

69
Q

what are 4 acquired causes of nystagmus

A

Vestibular lesions/inflammation/infection
Brain lesions/malformations
Muscle spasm
medications

70
Q

what is Neovascularization of immature vasculature seen in preemies (< 1500g)

A

retinopathy of preemie

71
Q

what can be induced by excess O2 supplementation, hypoxemia, illness

A

retinopathy

72
Q

what results in retinal detachment and vision loss

A

retinopathy

73
Q

how do you treat retinopathy?

A

medical or surgical ablation vessels by ophtho

74
Q

what is Inflammation of skin lining in the ear canal

A

otitis externa

75
Q

what are risk factors of otitis externa? 2

A

Water trapped “swimmers ear”

Trauma to canal from q tip

76
Q

what is the most common pathogen of otitis externa? 2nd?

A

Pseudomonas Aeuruginosa

Staph aureus

77
Q

what has Pain and itching, +/- purulent discharge, pain elicited with traction on pinna or tragus

A

otitis externa

78
Q

how do you treat otitis externa

A

Topical –2% acetic acid to restore ph …. Or antibiotic / corticosteroid drops . Cipro HC

79
Q

what do you never use for ear infections

A

aminoglycosides –>ototox

80
Q 
what has Grey TM
Air fluid levels
Bubbles
Little to no movement of TM
TM may be retracted
A

Otitis Media with Effusion (OME)

81
Q

what is either mucoid or serous

A

effusion

82
Q

what has Hx hearing loss, fullness of ear, maybe vertigo

A

OME

83
Q

when OME has no pain or fever..

A

acute

84
Q

what has Potential contributing factors: allergic rhinitis, tonsillar/adenoid hypertrophy, sinusitis, eustachian dysfunction

A

OME

85
Q

what is Result of post nasal drainage, URI/allergies

A

Eustachian Dysfunction

86
Q

what has Ear pain/fullness/popping sensation, decreased hearing

A

Eustachian Dysfunction

87
Q

person with Eustachian Dysfunction has increased risk of?

A

AOM/OME

88
Q

what is Inflammation –> poor pressure regulation middle ear

A

Eustachian Dysfunction

89
Q

what has pk incidence at 6-24 months

A

AOM

90
Q

what is Infection of middle ear cavity assoc with effusion

A

AOM

91
Q

what is recurrent OM

A

> 3 episodes in 6 months, or > 4 in 1 yr

92
Q

what may resent as Poor feeding, fever, pain / irritability, pulling on ear, vomiting and
Otoscopic findings

A

AOM

93
Q

what has Bulging TM
Impaired visiblility of landmarks
Red, white, yellow
Bullae

A

AOM

94
Q

what is the triad of findings with AOM

A

Recent, usually abrupt onset of illness (URI often)
Signs/symptoms of middle ear inflammation
Otalgia (ear tugging in infant), irritability/crying, otorrhea, and/or fever
Otoscopic findings ( evidence of effusion )
Bulging tympanic membrane (highest predictive value) , limited or absent mobility, air fluid level, or otorrhea

95
Q

what is the #1 cause of AOM

A

strep pneumo

96
Q

how do you treat a <6mo old with certain dx of AOM

A

abx

97
Q

how do you treat a <6mo old with uncertain diagnosis of AOM

A

abx

98
Q

what is treatment for 6mo old - 2 year old with certain dx of AOM

A

abx

99
Q

what is treatment for 6mo old - 2 year old with uncertain dx of AOM

A

Antibacterial therapy if severe illness; observation option if non-severe illness

100
Q

what is treatment for 2-12 y/o with certain dx of AOM

A

abx if severe; obs if not

101
Q

what is treatment for 2-12 y/o with uncertain dx of AOM

A

observation

102
Q

what is the DOC for AOM

A

amoxicillin

103
Q

what is 2nd line tx of AOM or 1st if severe w/fever?

A

Amoxicillin-clavulanate or ceftriaxone IV

104
Q

how do you avoid AOM

A

Breastfeeding for at least the first 6 months
Avoiding supine bottle-feeding (bottle propping)
Elimination of pacifier use in the second 6 months of life
Elimination of exposure to passive tobacco smoke
Don’t be a boy, don’t be LBW, don’t be born prematurely,
Don’t go to childcare,
Don’t have a cleft palate

105
Q

what is indicated for *chronic OME with conductive hearing loss or failed tx for recurrent AOM

A

PE tubes

106
Q

what are complications of OME/AOM

A

Hearing deficits, tympanoslerosis, perforation, mastoiditis

107
Q

what is white plaques on TM ‘scars’

Decrease mobility of TM

A

tympanosclerosis

108
Q

when can prophylactic abx be used for ear infection

A

AOM, not for OME

109
Q

what is the most common organism of mastoiditis

A

strep pneumo and pyogenes

110
Q

what has postauricular pain, fever, displacement of pinna.

A

mastoiditis

111
Q

what are 2 complications of mastoiditis

A

Meningitis is a complication so evaluate for stiff neck, high fever, severe headache, meningeal signs
Brain absess in 2% of pt – assoc with persistent headaches, recurrent fevers, neurologic changes

112
Q

how do you treat mastoiditis

A

Myringotomy to obtain culture. Hopitalization with IV ABX. If severe, corticalmastoidectomy.

113
Q

what is Growing mass of epithelial tissue within middle ear and temporal bone

A

cholesteatoma

114
Q

what is a mass that is Invasive to local structures damaging ear anatomy, may lead to permanent hearing loss. Invasion into bone and brain may lead to abscess, severe morbidity/mortality if untreated

A

cholesteatoma

115
Q

what can cause cholesteatoma

A

May be congenital or acquired (recurrent OM, TM injury)

116
Q

what is the mainstay tx of cholesteatoma

A

Surgical removal mainstay of Tx

117
Q

what is Most common cause of conductive hearing loss in children

A

OM

118
Q

when doesAAP recommends hearing and language evaluation in children

A

with OME >3months

119
Q

Sensorineural Hearing Loss (SNHL) is due to

A

to defect in cochlear recptor cells or auditory nerve (CN VIII)
Congenital or Acquired

120
Q

what are the risk factors of sensorineural HL (7)

A

LBW < 1500g , low apgars (0-4 at 1 min , 0-6 at 5min, hypoxia, TORCH, hyperbilirubinemia( kernicterus), mechanical ventilation > 5days

121
Q

acquired causes of SNHL(4)

A

Ototoxic medications – Gentamicin,
Infection – meningitis, syphillis, lyme disease
CMV – loss is progressive in ~ 50%
Autoimmune or neoplastic conditions

122
Q

how do you test hearing in birth to 4mo

A

startle to sounds

123
Q

how do you test hearing in 4 mo to 2 yrs

A

test by using soft soundmaker outside childs field of vision

124
Q

no teeth by ___ is concerning. what else is concerning

A

15mo

single tooth eruption - missing mirror pair

125
Q

what is risk of natal teeth

A

no roots so fall out –> aspirate

126
Q

1 pathogen of dental carries

A

strep viridans

127
Q

what is 10+ small mouth ulcers on buccal mucosa, anterior pillars, inner lips, tongue, gingiva (not posterior pharynx)
+ fever
+ cervical adenopathy

A

HSV

128
Q

how do you treat and not treat HSV?

A

symptoms.(no corticosteroids – spread infx) If caught early could start oral acyclovir

129
Q

what causes thrush?

A

candida albicans

130
Q

what is White curd-like plaques on inner cheeks

that Does not scrape off; child refuses feeding

A

thrush

131
Q

how do you treat thrush

A

Nystatin

132
Q

what is Erosions to mucosa of Unknown etiology but + familial component, has increased Incidence with stress, recent illness, irritants (spicy, acidic salty foods/drinks), and Vitamin deficiency
and is Not infection?

A

oral aphthae

133
Q

how do you treat oral aphthae

A

Dietary avoidance, mucosal protectants, pain mgmt

Pediatrics (9 decks)

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