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Old Peds > HEENT 2- Nose, Sinus, Throat > Flashcards

HEENT 2- Nose, Sinus, Throat Flashcards

1
Q

is rhinitis usually viral or bacterial?

A

Viral

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2
Q

what is the most common pediatric infectious dz?

A

Viral

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3
Q

How many colds do kids <5 get usually?

A

6-12 colds / years

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4
Q

when does rhinitis peak?

A

early fall to late spring

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5
Q

does color of mucus indicate bacterial infection?

A

No

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6
Q

patient presents with nasal congestions, mild sever, sore “scratchy throat” due to post nasal drip. Nose, throat, TM red+ inflamed.

A

Viral rhinitis

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7
Q

when do you call viral rhinitis sinusitis?

A

Until >10-14 days

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8
Q

Tx for viral rhinitis

A

antihistamines
decongestants
(only if >6 years old)

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9
Q

one cold after another

A 
recurrent rhinitis  (viral)
1/3 of these are allergic rhinitis or recurrent rhinosinusitis
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10
Q

patient presents w/ nasal congestions, sneezing, rhinorrhea, itchy nose, palate, throat and eyes.
Nasal turbinates swollen, red or pale pink

A

Allergic rhinitis

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11
Q

tx for allergic rhinitis

A

intranasal corticosteroids
oral and intranasal antihistamines
decongestants

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12
Q

if a kid <10 has nasal polyps, what would you be worried about?

A

cystic fibrosis

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13
Q

what is the number one cause of nose bleeds?

A

trauma up the nose

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14
Q

The nosebleed usual arises from the ___________ part of the nasal septum.

A

anterior Kiesselbach’s plexus

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15
Q

tx for epistaxis

A

leaning forward, clear passages, pinch nose below nasal bones, pack with gel sponge or foam.

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16
Q

would you get an x-ray for sinus problems on a 5 year old?

A

No, because they don’t have well developed sinuses

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17
Q

sinuses that present at birth pneumatized ~ 4 yr

A

maxillary sinuses

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18
Q

present and pneumatized at birth

A

ethmoid sinuses

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19
Q

sinuses develop by the 5th or 6th birthday

A

sphenoid

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20
Q

sinuses that begin dev 7th or 8th birthday- not fully dev until adolescence

A

frontal sinuses

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21
Q

Frontal sinusistis unusual before age _____

A

10 years

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22
Q

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.

A

Rhinosinusitis

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23
Q

is a PE helpful with rhinosinusitis?

A

not usually

may have sinus tenderness with older children

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24
Q

what bacterial are most sinusitis caused by?

A

Strep pneumo

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25
Q

viruses that cause sinusitis?

A

adenovirus
parainfluenza
influenza
rhinovirus

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26
Q

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

A

Chronic or recurrent rhinosinusitis

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27
Q

some cases what do you need to order with crhonic or recurrent rhinosinusitis?

A

CT

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28
Q

what should you ask your patient with recurrent sinusitis

A

allergies? reflux?

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29
Q

when should you get plain films for ABS?

A

older children with recurrent ABS
vague symptoms
poor response to therapy

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30
Q

first line tx for ABS

A

amoxicillin 90 mg/kg/day for 10-14 days (or 7 days after symptoms resolve) (lack of blood supply to the sinuses)

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31
Q

If it is chronic sinusitius or trying to avoid sx how do you treat ABS

A

amoxicillin for 3-4 weeks and add vancomycin

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32
Q

alternatives to amoxicillin

A

Cefuroxime axcetil, cefopodoxime, macrolides

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33
Q

if recent treatment with amoxicillin, or failure of clinical improvement on amoxicillin within 72 hours

A

give amoxicillin-clavulanate (augmentin)

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34
Q

sx for chronic sinusitis

A

adenoidectomy effective in 50-75% children with chronic.

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35
Q

adjuvant therapies for ABS

A

antihistamine, decongestants, anti-inflammatories (not a lot of data supporting this)
topical intranasal steroids (not a lot of benefit)
nasal irrigation w/ saline

36
Q

complications with rhinosinusitis

A 
orbital cellulitis (abscess, empyema) 
meningitis
37
Q

cellulitis found in the lids and skin surroudning the eye

A

Preseptal cllulitis

38
Q

cellulitis found back in the bone. behind the septum. will have greater fever, more widespread rxn

A

Orbital cellulitis

39
Q

most common organisms for preseptal cellulitis

A

staph aureus

strep pyogenes

40
Q

complications of orbital cellulitis

A

cavernous sinus thrombosis or meningitis

41
Q

organisms you think of for orbital cellulitis

A

respiratory flora and anerobes

staph auresus

42
Q

tx for orbital cellulitis

A

hospitalization
IV antibiotics
amy need sinus drainage

43
Q

Leading cause of halitosis in children is ____________________________

A

nasal foreign body

44
Q

anticongestant used to stop the swelling with an obstruction

A

pseudophed topical

45
Q

what is associated with strep throat.

A

petechiae

46
Q

the most common cause of pharyngitis is…..

A

viral (upwards on 90%)

usually adenovirus and enterovirus

47
Q

what is the name for pharyngoconjunctival virus?

A

adenovirus

48
Q

Caused by Coxsackie A. Ulcers 3 mm with halo on anterior pillars, soft palate, uvula

A

Herpangina

49
Q

Ulcers anywhere in the mouth/throat.

Vesicles, pustules, papules on palms, soles,interdigital, buttocks

A

Hand Foot Mouth by Coxsackie A

50
Q

what is Pharyngoconjunctival Fever caused by?

A

Adenovirus

51
Q

Fatigue, high fever, exudative pharyngitis, lymphadenopathy (ant & post cervical) splenomegaly, rash

A

Mono; EBV

52
Q

Labs to get for mono

A 
CBC
heterophile antibodies (monospot) may not appear until 2nd week of illness
53
Q

what is a white coating over the tonsils. Usually more membranous with mono.

A

Exudative pharyngitis

54
Q

where are lymph nodes especially enlarged in mono

A

posterior

55
Q

Tx for mono

A

Rest, fever control, steroids if airway obstruction, avoid contact sports if splenomaegaly

56
Q

what will seen on CBC with mono

A

> 10% atypical lymphocytes (usually have 0)

57
Q

what meds may cause a rash in someone with mono.

A

Penicillin + Amoxicillin

58
Q

what is definitive for diagnosis of mono

A

> 10% Atypical Lymphs in blood, or + Monospot, IgM for Epstein Barr is definitive

59
Q

headache and belly pain can indicate what?

A

Strep

60
Q

Acute onset, - fever ,headache , nausea (no cough, conjunctivitis, sneezy)

A

Bacterial pharyngitis

61
Q

who is bacterial pharyngitis most common in?

A

5-15 years old

62
Q

complications of bacterial pharyngitis

A

rheumatic fever
glomerulonephritis (abx doesn’t help this)
scarlet fever

63
Q

Complication of strep that presents with sandpaper rash on groin and torso.

A

Scarlet fever

64
Q

Diagnostics of strep throat

A 
throat culture (gold standard)
rapid antigen test (negative doesn't guarantee) 
do both of these
65
Q

tx for bacterial pharyngitis

A

Penicillin V BID/TID for 10 days

amoxicillin and ampicillin are acceptable

66
Q

when should you give Pen G shot to someone with bacterial pharyngitis?

A

won’t follow up

67
Q

next best choice for strep throat if allergic to penicillin

A

Erythromycin

68
Q

is test of cure needed for strep throat

A

no, carrier state is usually self limited and not contagious
little risk for rheumatic fever
but tx if they have recurrent infections

69
Q

antistreptococcal antibodies form immune complexes that cross react cardiac sarcolemma antigens causing inflammatory response in myocardium and valves .

A

Rheumatic Fever

70
Q

antigen-antibody complexes deposit in glomeruli and incite inflammation and activate the complement system.

A

Acute glomerulonephritis

71
Q

who does rheumatic fever have a greater incidence in?

A

girls

african americans

72
Q

pt. presetns with tea or cola color urine- gross hematuria after having strep.

A

Acute Glomerulonephritis

73
Q

Tx for Acute Glomerulonephritis

A

supportive, (dietary, diuretics or hypertensives) most recover completely 2-3wk

74
Q

patient presents with severe sore throat, high fever, one beefy red tonsil. patient previously have group A strep

A

Peritonsillar Abscess (quinsy)

75
Q

tx for peritonsilar abscess

A

penicillin or clindamycin

76
Q

Patient presents with Fever, Respiratory symptoms, Neck hyperextension
Dysphoria, drooling, dyspnea

A

Retropharyngeal Abscess

77
Q

organisms that cause retropharyngeal abscess

A

GAS

staph aureus

78
Q

who is retropharyngeal Abscess often seen in

A

3 years and younger

79
Q

Tx for retropharyngeal Abscess

A

Surgical emergency

hospitalization with IV PCN or clindamycin

80
Q

most often lymph node involved in acute cervical adenitis

A

Anterior cervical node (tends to be a single node, mono has more)

81
Q

Patient presents with neck pain and dysphagia, high fever. Often caused by GAS

A

acute cervical adenitis

82
Q

tx for acute cervical adenitis

A

penicillin IM or IV antibiotics

83
Q

what are tonsillectomy and adenoidectomy reserved for

A 
Obstructive sleep apnea
recurrent infection
Swallowing disorders (speech abnormality)
84
Q

Short lingual frenulum

Can cause feeding problems, speech problems, dental problems

A

Ankyloglossia

85
Q

when does someone need to be referred for ankyloglossia

A

tongue cannot protrude beyond gums

86
Q

tx for ankyloglossia

A

frenulectomy

87
Q

pink eye” and now sore throat. On exam you find conjunctivitis, enlarged beefy red tonsills, and cervical lymphadenopathy

A

Adenovirus

Old Peds (15 decks)

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