HEENT 2- Nose, Sinus, Throat Flashcards
is rhinitis usually viral or bacterial?
Viral
what is the most common pediatric infectious dz?
Viral
How many colds do kids <5 get usually?
6-12 colds / years
when does rhinitis peak?
early fall to late spring
does color of mucus indicate bacterial infection?
No
patient presents with nasal congestions, mild sever, sore “scratchy throat” due to post nasal drip. Nose, throat, TM red+ inflamed.
Viral rhinitis
when do you call viral rhinitis sinusitis?
Until >10-14 days
Tx for viral rhinitis
antihistamines
decongestants
(only if >6 years old)
one cold after another
recurrent rhinitis (viral) 1/3 of these are allergic rhinitis or recurrent rhinosinusitis
patient presents w/ nasal congestions, sneezing, rhinorrhea, itchy nose, palate, throat and eyes.
Nasal turbinates swollen, red or pale pink
Allergic rhinitis
tx for allergic rhinitis
intranasal corticosteroids
oral and intranasal antihistamines
decongestants
if a kid <10 has nasal polyps, what would you be worried about?
cystic fibrosis
what is the number one cause of nose bleeds?
trauma up the nose
The nosebleed usual arises from the ___________ part of the nasal septum.
anterior Kiesselbach’s plexus
tx for epistaxis
leaning forward, clear passages, pinch nose below nasal bones, pack with gel sponge or foam.
would you get an x-ray for sinus problems on a 5 year old?
No, because they don’t have well developed sinuses
sinuses that present at birth pneumatized ~ 4 yr
maxillary sinuses
present and pneumatized at birth
ethmoid sinuses
sinuses develop by the 5th or 6th birthday
sphenoid
sinuses that begin dev 7th or 8th birthday- not fully dev until adolescence
frontal sinuses
Frontal sinusistis unusual before age _____
10 years
Infection of paranasal sinuses
Almost always preceded by URI.
Nasal drainage, congestions, facial pressure or pain, PND, fever, cough, fatigue, maxillary dental pain, ear pressure or fullness. HA.
Rhinosinusitis
is a PE helpful with rhinosinusitis?
not usually
may have sinus tenderness with older children
what bacterial are most sinusitis caused by?
Strep pneumo
viruses that cause sinusitis?
adenovirus
parainfluenza
influenza
rhinovirus
recurrence of rhinosinusitis. Hx that every time they get a cold they get sinusitis. Chronic if patient hasn’t cleared infection in expected amount of time
Chronic or recurrent rhinosinusitis
some cases what do you need to order with crhonic or recurrent rhinosinusitis?
CT
what should you ask your patient with recurrent sinusitis
allergies? reflux?
when should you get plain films for ABS?
older children with recurrent ABS
vague symptoms
poor response to therapy
first line tx for ABS
amoxicillin 90 mg/kg/day for 10-14 days (or 7 days after symptoms resolve) (lack of blood supply to the sinuses)
If it is chronic sinusitius or trying to avoid sx how do you treat ABS
amoxicillin for 3-4 weeks and add vancomycin
alternatives to amoxicillin
Cefuroxime axcetil, cefopodoxime, macrolides
if recent treatment with amoxicillin, or failure of clinical improvement on amoxicillin within 72 hours
give amoxicillin-clavulanate (augmentin)
sx for chronic sinusitis
adenoidectomy effective in 50-75% children with chronic.
adjuvant therapies for ABS
antihistamine, decongestants, anti-inflammatories (not a lot of data supporting this)
topical intranasal steroids (not a lot of benefit)
nasal irrigation w/ saline
complications with rhinosinusitis
orbital cellulitis (abscess, empyema) meningitis
cellulitis found in the lids and skin surroudning the eye
Preseptal cllulitis
cellulitis found back in the bone. behind the septum. will have greater fever, more widespread rxn
Orbital cellulitis
most common organisms for preseptal cellulitis
staph aureus
strep pyogenes
complications of orbital cellulitis
cavernous sinus thrombosis or meningitis
organisms you think of for orbital cellulitis
respiratory flora and anerobes
staph auresus
tx for orbital cellulitis
hospitalization
IV antibiotics
amy need sinus drainage
Leading cause of halitosis in children is ____________________________
nasal foreign body
anticongestant used to stop the swelling with an obstruction
pseudophed topical
what is associated with strep throat.
petechiae
the most common cause of pharyngitis is…..
viral (upwards on 90%)
usually adenovirus and enterovirus
what is the name for pharyngoconjunctival virus?
adenovirus
Caused by Coxsackie A. Ulcers 3 mm with halo on anterior pillars, soft palate, uvula
Herpangina
Ulcers anywhere in the mouth/throat.
Vesicles, pustules, papules on palms, soles,interdigital, buttocks
Hand Foot Mouth by Coxsackie A
what is Pharyngoconjunctival Fever caused by?
Adenovirus
Fatigue, high fever, exudative pharyngitis, lymphadenopathy (ant & post cervical) splenomegaly, rash
Mono; EBV
Labs to get for mono
CBC heterophile antibodies (monospot) may not appear until 2nd week of illness
what is a white coating over the tonsils. Usually more membranous with mono.
Exudative pharyngitis
where are lymph nodes especially enlarged in mono
posterior
Tx for mono
Rest, fever control, steroids if airway obstruction, avoid contact sports if splenomaegaly
what will seen on CBC with mono
> 10% atypical lymphocytes (usually have 0)
what meds may cause a rash in someone with mono.
Penicillin + Amoxicillin
what is definitive for diagnosis of mono
> 10% Atypical Lymphs in blood, or + Monospot, IgM for Epstein Barr is definitive
headache and belly pain can indicate what?
Strep
Acute onset, - fever ,headache , nausea (no cough, conjunctivitis, sneezy)
Bacterial pharyngitis
who is bacterial pharyngitis most common in?
5-15 years old
complications of bacterial pharyngitis
rheumatic fever
glomerulonephritis (abx doesn’t help this)
scarlet fever
Complication of strep that presents with sandpaper rash on groin and torso.
Scarlet fever
Diagnostics of strep throat
throat culture (gold standard) rapid antigen test (negative doesn't guarantee) do both of these
tx for bacterial pharyngitis
Penicillin V BID/TID for 10 days
amoxicillin and ampicillin are acceptable
when should you give Pen G shot to someone with bacterial pharyngitis?
won’t follow up
next best choice for strep throat if allergic to penicillin
Erythromycin
is test of cure needed for strep throat
no, carrier state is usually self limited and not contagious
little risk for rheumatic fever
but tx if they have recurrent infections
antistreptococcal antibodies form immune complexes that cross react cardiac sarcolemma antigens causing inflammatory response in myocardium and valves .
Rheumatic Fever
antigen-antibody complexes deposit in glomeruli and incite inflammation and activate the complement system.
Acute glomerulonephritis
who does rheumatic fever have a greater incidence in?
girls
african americans
pt. presetns with tea or cola color urine- gross hematuria after having strep.
Acute Glomerulonephritis
Tx for Acute Glomerulonephritis
supportive, (dietary, diuretics or hypertensives) most recover completely 2-3wk
patient presents with severe sore throat, high fever, one beefy red tonsil. patient previously have group A strep
Peritonsillar Abscess (quinsy)
tx for peritonsilar abscess
penicillin or clindamycin
Patient presents with Fever, Respiratory symptoms, Neck hyperextension
Dysphoria, drooling, dyspnea
Retropharyngeal Abscess
organisms that cause retropharyngeal abscess
GAS
staph aureus
who is retropharyngeal Abscess often seen in
3 years and younger
Tx for retropharyngeal Abscess
Surgical emergency
hospitalization with IV PCN or clindamycin
most often lymph node involved in acute cervical adenitis
Anterior cervical node (tends to be a single node, mono has more)
Patient presents with neck pain and dysphagia, high fever. Often caused by GAS
acute cervical adenitis
tx for acute cervical adenitis
penicillin IM or IV antibiotics
what are tonsillectomy and adenoidectomy reserved for
Obstructive sleep apnea recurrent infection Swallowing disorders (speech abnormality)
Short lingual frenulum
Can cause feeding problems, speech problems, dental problems
Ankyloglossia
when does someone need to be referred for ankyloglossia
tongue cannot protrude beyond gums
tx for ankyloglossia
frenulectomy
pink eye” and now sore throat. On exam you find conjunctivitis, enlarged beefy red tonsills, and cervical lymphadenopathy
Adenovirus
