HEENT

Question 1

FIrst Line Treatment of AOM

Answer 1

Amoxicillin 80-90mg/kg/day Q12 for 10 days

Question 2

Treatment of AOM if allergic to Amoxicillin

Answer 2

1. Cefdinir 14 mg/kg/day for 10 days ($$$)
2. Clindamycin 30-40 mg/kg/ay Q8 for 10 days
3. Ceftriaxone 50 mg/kg daily x 3 days

Question 3

Characteristics of Gonococcal Conjunctivitis

Answer 3

1. Severe bilateral purulent discharge

2. Conjunctival inflammation, lid edema, erythema

Question 4

Systemic symptoms of Gonococcal Conjunctivitis

Answer 4

Systemic symptoms: rhinitis, stomatitis, anorectal

infection, SEPTICEMIA, MENINGITIS, BLINDNESS

Question 5

Symptoms of Chlamydial conjunctivitis

Answer 5

1. Symptoms can be mild to moderate
2. Mild hyperemia
3. Moderate mucoid drainage

Question 6

Workup for neonatal conjunctivitis

Answer 6

1. Eye cultures
2. Septic workup
3. CBC with differential
4. Basic Metabolic Profile
5. Lumbar puncture
6. CSF: culture with gram stain, viral
   culture, herpes PCR, glucose,
   protein, cell count
7. Urinalysis and Urine Culture by
   catheter
8. Chest X-ray
9. ID Consult
10. Admit

Question 7

Which type of conjunctivitis should regard concern for pneumonia?

Answer 7

Chlamydial Conjunctivitis

Question 8

Treatment of Gonococcal Conjunctivitis in Neonates

Answer 8

1. Topical erythromycin PLUS
2. Ceftriaxone 25-50 mg/kg once (max
   125 mg) AND
3. Azithromycin 20mg/kg as a single
   dose (max 1,000mg/dose)

Question 9

Treatment of Chlamydial Conjunctivitis in Neonates

Answer 9

1. Erythromycin Ethylsuccinate 50
   mg/kg/day Q6H for 14 days OR
2. Azithromycin 20 mg/kg for 3 days

Question 10

Pathogens for Bacterial Conjunctivitis in

Answer 10

H. influenzae 
Moraxella
Catarrhalis 
S. aureus 
S. pneumoniae 
Pseudomonas (contact lens wearers) 
STDs

Question 11

Viral Conjunctivitis Symptoms

Answer 11

Sticky eyelashes 
Start in one eye and to other moves to other 
URI symptoms
Non purulent watery discharge 
Purulent discharge

Question 12

Pathogens for Viral Conjunctivitis

Answer 12

Adenovirus 
Coxsackievirus 
Enterovirus 
HSV 
Zika virus

Question 13

Symptoms of Allergic Conjunctivitis

Answer 13

Itching predominates

Clear rhinorrhea

Question 14

Treatment of Pediatric Bacterial Conjunctivitis

Answer 14

1. Polymyxin B/Trimethoprim ophthalmic 1 drop OU Q6H for 7-10 days
2. Ciprofloxacin 1 drop OU Q4H for 7 days

Question 15

Treatment of Viral Conjunctivitis in Pediatrics

Answer 15

Supportive
Hand hygiene
Cold compresses
Artificial tears or ocular lubricant

Question 16

Treatment of Allergic Conjunctivitis in Pediatrics

Answer 16

1. Treat the allergies with Cetirizine or Loratadine

2. Ketotifen 0.025% 1 drop Q12H PRN (children > 3yr)

Question 17

When to treat AOM

Answer 17

Sever symptoms requiring immediate treatment include otalgia for 48 hours, fever 39ºC or greater, unilateral or bilateral exam Effusion must be present for a diagnosis of AOM

Question 18

Treatment of Otitis Externa

Answer 18

Ciprofloxacin 5 drops both ears BID for 5-7 days

Question 19

What is Bacterial Pharyngitis (Group A Strep throat)?

Answer 19

Sudden onset of sore throat 
Fever, 
Tonsilpharyngeal erythema 
Beefy swollen uvula
No URI symptoms Rapid Strep

Question 20

Treatment of Bacterial Pharyngitis?

Answer 20

1. AAP recommends Pen V 50-75 mg/kg BID or TID
2. BUT….Amoxicillin is better tolerated both due to taste and due to GI absorption Amoxicillin 50 mg/kg/day (MAX dose for strep is 1 gm/day) and can be given as a single dose

Question 21

Treatment of Bacterial Pharyngitis if Allergic to Penicillin?

Answer 21

Azithromycin