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Pediatrics - clinical > HEENT > Flashcards

HEENT Flashcards

1
Q

What is the presentation of acute otitis media

A

bulging of TM
other signs of acute inflammation (erythema of TM, fever, ear pain
middle ear effusion

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2
Q

what are the common pathogens causing Acute otitis media

A

S. Pneumoniae (25%)
H. Influenzae (20%)
M. Catarrhalis

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3
Q

how do you diagnose Acute Otitis Media

A

otoscope examination
- bulging, loss of landmarks, redness, TM injection

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4
Q

what is the treatment of acute otitis media

A

high dose amoxicillin or Augmentin or cephalosporin (penicillin allergic)

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5
Q

what is the duration of treatment for acute otitis media

A

< 2years old: 10 days
>2 years old: 5-7 days

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6
Q

what are other non medication treatments for recurrent acute otitis media

A

tympanostomy
tympanocentesis
myringotomy

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7
Q

what are complications of acute otitis media

A

mastoiditis and bullous myringitis

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8
Q

what is the most common cause of pharyngitis

A

viral - adenovirus is m/c

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9
Q

what is the presentation of mononucleosis phayngotonsillitis

A

fever
sore throat
lymphadenopathy
splenomegaly
atypical lymphocytes
+ heterophile agglutination test (monospot)

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10
Q

when should gonorrhea pharyngitis be considered

A

in pts with recent sexual encounters or with non-resolving pharyngitis

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11
Q

when should fungal pharyngitis be considered

A

pts using inhaled steroids

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12
Q

what is the cause of step pharyngitis

A

Group A B-hemolytic streptococci (GABHS) - S. pyogenes

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13
Q

How is strep pharyngitis diagnosed

A

Centor Score (3 or 4)
1. absence of a cough
2. exudates
3. fever (>100.4)
4. cervical lymphadenopathy

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14
Q

if patient has a negative Centor score, what is the next step

A

throat culture

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15
Q

what is the treatment of Group A Strep pharyngitis

A

Penicillin = first line
azithromycin if penicillin allergic

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16
Q

what are complications of strep pharyngitis

A

rheumatic fever
post-strep glomerulonephritis

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17
Q

what is the treatment of mononucleosis pharyngitis

A

symptomatic and avoid contract sports; abx such as amoxicillin or ampicillin may cause a rash

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18
Q

when can people return to sport s/p mononucleosis diagnosis

A

for athletes planning to resume non-contact sports: 3 weeks from symptom onset
for strenuous contact sports: 4 weeks after illness onset

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19
Q

what is the treatment of fungal pharyngitis

A

clotrimazole
miconazole
or nystatin

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20
Q

what is the treatment of gonorrhea pharyngitis

A

IM ceftriaxone and azithromycin for second agent

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21
Q

pt presents with clear nasal drainage, pruritis, pale, blish, boggy mucosa, what is their likely diagnosis

A

allergic rhinitis

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22
Q

how do you diagnose allergic rhinitis

A

history and occasionally skin testing

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23
Q

what is the treatment options for allergic rhinitis

A

avoid any known allergins
use antihistamines
cromolyn sodium
nasal or systemic corticosteroids
nasal saline drops or washes
immunotherapy

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24
Q

what is the presentation of viral conjunctivitis

A

copious watery discharge, scant mucoid discharge.

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25
Q

what is the most common bug cause of viral conjunctivitis

A

Adenovirus

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26
Q

what is the presentation of bacterial conjunctivitis

A

purulent (yellow) discharge, crusting, usually worse in AM/ may be unilateral

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27
Q

what are the common causes of bacterial conjunctivitis

A
  • s. pneumonia, s. aureus - acute mucopurulent
  • M. catarrhalis, gonococcal - those not responding to conventional treatment
  • chlamydia - newborn
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28
Q

how do you diagnose chlamydia conjunctivitis

A

Giemsa stain - inclusion body

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29
Q

what is the presentation of allergic conjunctivitis

A

red eyes
itching and tearing
usually bilateral
cobblestone mucosa in inner/upper eyelid

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30
Q

what is the treatment of bacterial conjunctivitis

A

Gentamicin/tobramycin (tobrex)
Erythromycin ointment - chlamydia for newborns
Trimethobrim and polymyxin B

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31
Q

what needs to be added for coverage in bacterial conjunctivitis with those who wear contact lenses

A

fluoroquinolones

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32
Q

what is the treatment of Neisseria conjunctivitis in those with contact lenses

A

prompt referral and topical and systemic abx

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33
Q

what is the treatment of chlamydial conjunctivitis with those using contact lenses

A

systemic tetracyclines or erythromycin x 3weeks
topical ointments
assess for STD or child abuse

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34
Q
A
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35
Q

what is the pathogen that causes epiglottitis

A

Haemophilus infleunzae type B (Hib)
- usually unvaccinated children or underserved areas

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36
Q

when is Hib vaccine administered in kids

A

2,4,6,12-15 months

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37
Q

what is the presentation of epiglotittis

A

stridor, restlessness, cough, dyspnea, fever, dysphagia, drooling, respiratory distress (tripod)

38
Q

what are the 3D’s of epiglottitis

A

Dysphagia
Drooling
Respiratory Distress

39
Q

how do you diagnose epiglotitis

A

secure airway
culture for H. flu
lateral neck x-ray

40
Q

what is the hallmark sign on x-ray for epiglotitis

A

thumbprint sign

41
Q

what is the treatment of epiglotitis

A

intubation if necessary
supportive care
ceftriaxone
may tx outpt if stable

42
Q

what is the most common site for anterior nose bleeds

A

kiesselbach’s plexus or Little’s area

43
Q

what is the typical source for posterior nose bleeds

A

sphenopalatine artery (woodruff’s plexus)

44
Q

what is important to preventatively treat for with patients who require anterior nasal packing for nosebleeds

A

must be treated with abx (cephalosporin) to prevent toxic shock syndrome

45
Q

what should be ruled out with recurrent epistaxis

A

HTN or hypercoagulable disorder

46
Q

what is Weber Test

A

tuning fork placed on center of the head to see if the sound lateralizes

47
Q

for a webers test, if the sound lateralizes to the affected side, what does that indicate?

A

conductive hearing loss

48
Q

for weber test, if the sound lateralizes to the unaffected ear, what does that indicate

A

sensorineural hearing loss

49
Q

what is the rinne test

A

tuning fork placed on mastoid then up the the hear (should continue to hear)

50
Q

in a rinne test, if it results in bone > air what does that indicate?

A

conductive hearing loss

51
Q

in rinne test, if it results in air > bone, what does that indicate?

A

sensorineural hearing loss

52
Q

if a patient has conductive hearing loss, what should the results of the WEber and Rinne test be?

A

Weber: hear in the bad ear
Rinne: Bone > air

53
Q

if a patient has sensorineural hearing loss what should the results of their weber and rinne be?

A

Weber: hear in good ear
Rinne: Air>bone

54
Q

what are common causes of sensorineural hearing loss

A

noise-induced, infection, drug-induced, congenital, meniere disease, CNS lesions

55
Q

what are common causes of conductive hearing loss

A

cerumen impaction, otitis external, esostosis
tmpanic membrane perforation
otitis media, otosclerosis, neoplasms

56
Q

what is exostosis

A

bony outgrowths of external auditory canal related to exposure to cold water

57
Q

what is a complication of acute otitis media that leads to a suppurative infection of mastoid air cells

A

mastoiditis

58
Q

what is the presentation of mastoiditis

A

fever
otalgia
pain and erythema of ear
forward displacement of external ear

59
Q

what are common pathogens causing mastoiditis

A

S. pneumonia, H. influenzae. M. catarrhalis, S. aureas, S. pyogenes

60
Q

how do you diagnose mastoiditis

A

clinical
CT of temporal bone with contrast (complicated/toxic)

61
Q

how do you treat mastoiditis

A

oral abx or IV abx (ceftriaxone)

62
Q

how is oral candidiasis diagnosed

A

potasium hydroxide prep (KOH) = revealing budding yeast and pseudohyphae

63
Q

what is the treatment of oral candidiasis

A

nystatin
oral fluconazole

64
Q

what is an infection of the orbital muscles and fat behind the eye

A

orbital cellulitis

65
Q

what is periorbital cellulitis

A

infection of only the skin around the eye

66
Q

what is the presentation of orbital cellulitis

A

decrease EOM
pain with movement of eye and proptosis
signs of infection

67
Q

how do you diagnose orbital cellulitis

A

CT scan of orbits confirm
CBC and blood cultures occasioanlly

68
Q

how do you treat orbital cellulitis

A

Hospitalization and IV broad-spectrum abx (vanco)

69
Q

what is the presentation of bacterial otitis externa

A

edema with cheesy white discharge, palpitation of the tragus is painful

70
Q

when is malignant otitis externa commonly seen

A

in diabetic patients

71
Q

what are the pathogens that cause bacterial otitis externa

A

pseudomonas aeruginoasa (swimmers ear)
S.aureus (digital trauma)

72
Q

what is the treatment of bacterial otitis externa with performation or chance of perforation

A

ciprofloxacin 0.3% and dexamethasone 0.1% suspension: 4 drops BID for 7 days
or
ofloxacin 0.3% solution 10 drops once daily for 7 days

73
Q

what drops are commonly used for bacterial otitis media

A

cortisporin otic drops

74
Q

what is the treatment of diabetic or immunocompromised pts with bacterial otitis externa

A

hospitalization with IV abx (caused by aspergillus)

75
Q

what is the presentation of fungal otitis externa

A

pruritis
weeping
pain and hearing loss
swollen, moist and wet appearance

76
Q

what is the pathogen causing fungal otitis externa

A

Aspergillus niger (black)
A.flavus (yellow)
A. fumigatus (grey)
candida albicans

77
Q

what are the treatment options for fungal otitis externa

A

2% acetic acid 2-4 drops QID
clotrimazole 1% solution
itraconazole oral

78
Q

pt presents with a severe sore throat, lateral uvula displacement and bulging tonsil what is the likely diagnosis

A

peritonsillar abscess

79
Q

what is the common pathogen causing peritonsillar absecesses

A

streptococcus pyogenes

80
Q

how do you diagnose peritonsil abscess

A

XR, CT or US of neck
needle aspiration of tonsillar mass and cultures

81
Q

what is the treatment for a peritonsilar abscess

A

aspiration
I&D
and/or
abx
(IV amox, ambox-sulbactam, clinda)

82
Q

what is exotropia

A

out-turning of eyes

83
Q

what is esotropia

A

in-turning of eyes

84
Q

what is hypertropia

A

upward deviation of eyes

85
Q

what is hypotropia

A

downward deviation of eyes

86
Q

how are stabismus diagnosed?

A

cover/uncover test

87
Q

what is the presentation of TM perforation

A

pain
otorrhea
hearing loss/reduction

88
Q

what is the treatment of TM perforation

A

most heal spontaneously
keep clean and dry
treat with abx

89
Q

what antibiotics are non-ototoxic

A

floxin drops

90
Q

when should surgery be persued with TM perforation

A

if it persists past 2 months

Pediatrics - clinical (13 decks)

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