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Pediatrics > HEENT > Flashcards

HEENT Flashcards

1
Q

Until what age do we always measure head circumference?

A

36 months

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2
Q

Esostrabismus?

A

Nasal deviation

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3
Q

Exostrabismus?

A

Temporal deviation

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4
Q

Hyper-strabismus?

A

eye more superior

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5
Q

Hypostrabismus?

A

Eye more depressed

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6
Q

What are some of the risk factors to strabismus?

A

Family history, low birth weight, prematurity, vision impairment

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7
Q

What are some complications of strabismus?

A

Amblyopia, diplopia, contractures or torticollis

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8
Q

how do you treat strabismus?

A

refer to ophthalmology

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9
Q

What is pseudostrabismus, and how do you confirm?

A

Optical illusion, seen in children with wide nasal bridge – confirm with corneal light reflex

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10
Q

If a child has unilateral purulent nasal drainage, epistaxis, with mouth breathing – what should you expect?

A

Nasal foreign body

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11
Q

What are the worst items to be swallowed or put up the nose? Thus, keep them far from children.

A

Small batteries & small magnets

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12
Q

If a child has a pseudocyst on buccal mucosa what diagnosis & how do you treat?

A

Mucoceles & refer to ENT, don’t excise

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13
Q

If a child has a pseudocyst of the sublingual gland, what diagnosis & how do you treat?

A

Ranulas & refer to ENT, don’t excise

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14
Q

What temperature is considered a fever in a child?

A

> 100.5

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15
Q

What is normal pulse ox in a child?

A

> 93%

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16
Q

When you are seeing a child in clinic for the first time, what must you always ask about?

A

Birth Hx = Gestational age at birth, complications of pregnancy/delivery, & mom’s GBS status

Interval Hx = recent office/ED/hospital visits or other injuries or illness

Chronic illnesses = Asthma

Immunization status

Second-hand smoke & child care arrangements

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17
Q

What should you always examine last in a child?

A

Ear & mouth

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18
Q

What are the 3 most common bacterial causes of infection?

A

Streptococcus Pneumoniae

Moraxella catarrhalis

Haemophilus influenza

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19
Q

If a child has a sore throat, rhinorrhea, sneezing, cough, and low grade temp – what diagnosis? How do we treat it?

A

Common cold

NO ABX!!!


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20
Q

How many colds do young children have/year?

A

7 (can last up to 14 days = 98 days of the year)

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21
Q

Does the color of snot have anything to do with bacterial cultures?

A

NO

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22
Q

What bacteria commonly causes refractory AOM? What has decreased the incidence of this?

A

S. pneumonia

Prevnar vaccine

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23
Q

What is the most common cause of bilateral AOM & conjunctivitis?

A

H. influenza

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24
Q

What bacteria most commonly causes mastoiditis?

A

Group A streptococcus

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25
Q

What are some of the symptoms AOM can cause?

A

Otalgia, fever, irritability, vomiting, and diarrhea

26
Q

What if the child has a really high fever and you see red, swollen, irritated looking ear drum?

A

Keep looking… AOM will NOT cause a high-fever

27
Q

Who needs to be treated with AOM?

A

Children under 2 with bilateral sxs

Children over 2 observe if minimal sxs and unilateral disease

28
Q

So, how do you treat AOM?

A

NSAIDs, APAP, Auralgan drops if OLDER than 2, Amoxicillin HIGH DOSE

29
Q

When do we use Amoxicillin/clavulanate?

A

If treated with Abx in the past months & if they also have conjunctivitis

30
Q

What is sinusitis, and what is its normal course?

A

Viral infection – associated with the common cold

Usually resolves in 7-10 days – AKA NO ABX!!!

31
Q

What is it called when sinusitis continues for longer than 10 days?

A

Acute bacterial rhinosinusitis – bacterial infection (give ABx)

32
Q

How does a child present with sinusitis?

A

Cough, nasal sxs, HA, and possibly a fever

33
Q

If a mother calls back and it’s been 10 days and the child is not getting better with their sinusitis sxs, what do we treat it with? What are we preventing?

A

Tx = Amoxicillin/clavulanate AKA Augmentin (high dose for more severe)

Prevent = preseptal cellulitis, orbital cellulitis, septic cavernous sinus thrombuosis, and meningitis.

34
Q

If a child has a very high fever (>104) with no other sxs, what diagnosis do we need to keep in the back of our minds?

A

Roseola

35
Q

How do you diagnose and treat?

A

Dx = clinical (often a rash presents on the 4th or 5th day), but often a diagnosis of exclusion

Tx = Supportive

36
Q

What disease causes a low grade fever, HA, and rhinorrhea, along with a slapped cheek rash?

A

Fifth’s disease

37
Q

What bacteria causes 5th’s disease?

A

Parvovirus B-19

38
Q

If a child has 5th’s disease, who do they need to stay away from?

A

Immunosuppressed adults & preggo ladies

39
Q

What are the 2 common pathogens of impetigo?

How do you treat it?

A

S. aureus & GAS

Tx = Topical mupirocin (must remove the crust first!) or Dicloxicillin

40
Q

If a mother says that she thinks the child had a spider bite, what do you need to think of and r/o?

A

MRSA

41
Q

What disorder causes a high fever in a child, with stridor, drooling and a sore throat?

A

Epiglottitis

42
Q

What causes epiglottitis?

A

Haemophilus influenza type B

43
Q

Is epiglottitis preventable?

A

YEP! Hib vaccine

44
Q

If a child presents with a sore throat, myalgia, abdominal pain and no URI sxs – what diagnosis?

A

Strep pharyngitis

45
Q

What causes strep pharyngitis?

A

Group A Streptococcus

46
Q

How do you treat strep and what are you preventing?

A

Amoxicillin

Prevent peritonsillar abscess, mastoiditis, and rheumatic fever (does not prevent glomerulonephropathies)

47
Q

If a patient has a hot potato voice with drooling and trismus (spasm of the neck muscles), what diagnosis?

A

pertonsillar abscess

48
Q

What is the first virus to be associated with cancers in humans?

A

Epstein-Barr virus

49
Q

What are some of the acute infectious sxs of EBV?

A

Malaise, HA, fever, exudative tonsillitis, with posterior cervical adenopathy

50
Q

how do you diagnose EBV?

A

CBC with diff (shows atypical lymphocytes), Heterophile antibodies (mono spot), EBV specific serology

51
Q

If we diagnose a kid with EBV, what must we do?

A

Take them out of contact sports = splenic rupture

52
Q

What else can EBV cause (common in Africa)?

A

Burkitt lymphoma

53
Q

What 3 diagnosis’s should you always have on your differential list when evaluating a febrile child??

A

Bacterial meningitis, Kawasaki’s disease, and UTI

54
Q

How does Kawasaki’s disease present?

A

Fever x 5 days, conjunctivitis, mucositis (“strawberry tongue”), rash, and extremity changes (edema, erythema, desquamation)

55
Q

What disease is highly contagious, spread via droplets which can remain airborne for hours, with a maculopapular rash, and koplik spots on buccal mucosa?

A

Measles

56
Q

What disease is highly infectious and spreads rapidly in closed spaces via droplets and results in swelling of the parotid gland?

A

Mumps

57
Q

What disease can be transmitted to the developing fetus and results in damaged blood vessels and ischemia in affected organs?

A

Rubella

58
Q

How do we treat otitis externa?

A

Floroquinolone – Ofloxacin

Can add topical glucocorticoids to decrease inflammation

59
Q

How do you treat mastoiditis?

A

Hospital admission with IV Abx

60
Q

If a mother brings in a child due to their hoarse voice, what must you rule out?

A

Croup or parainfluenza virus

Otherwise rule out: tumors, trauma, endocrine, GERD, or congenital abnormalities

61
Q

If a child has itchy, watery eyes, that are injected – what diagnosis? How do you treat it?

A

Allergic conjunctivitis

Treat with anti-histamine & cool compresses

Could also be viral (common in mid-summer to early fall)

62
Q

If a child has red eyes that are stuck together with mucopurulent discharge – what diagnosis? How do you treat?

A

Bacterial conjunctivitis

Treat with floroquinolones

Pediatrics (12 decks)

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