HEENT Flashcards
Until what age do we always measure head circumference?
36 months
Esostrabismus?
Nasal deviation
Exostrabismus?
Temporal deviation
Hyper-strabismus?
eye more superior
Hypostrabismus?
Eye more depressed
What are some of the risk factors to strabismus?
Family history, low birth weight, prematurity, vision impairment
What are some complications of strabismus?
Amblyopia, diplopia, contractures or torticollis
how do you treat strabismus?
refer to ophthalmology
What is pseudostrabismus, and how do you confirm?
Optical illusion, seen in children with wide nasal bridge – confirm with corneal light reflex
If a child has unilateral purulent nasal drainage, epistaxis, with mouth breathing – what should you expect?
Nasal foreign body
What are the worst items to be swallowed or put up the nose? Thus, keep them far from children.
Small batteries & small magnets
If a child has a pseudocyst on buccal mucosa what diagnosis & how do you treat?
Mucoceles & refer to ENT, don’t excise
If a child has a pseudocyst of the sublingual gland, what diagnosis & how do you treat?
Ranulas & refer to ENT, don’t excise
What temperature is considered a fever in a child?
> 100.5
What is normal pulse ox in a child?
> 93%
When you are seeing a child in clinic for the first time, what must you always ask about?
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
What should you always examine last in a child?
Ear & mouth
What are the 3 most common bacterial causes of infection?
Streptococcus Pneumoniae
Moraxella catarrhalis
Haemophilus influenza
If a child has a sore throat, rhinorrhea, sneezing, cough, and low grade temp – what diagnosis? How do we treat it?
Common cold
NO ABX!!!
How many colds do young children have/year?
7 (can last up to 14 days = 98 days of the year)
Does the color of snot have anything to do with bacterial cultures?
NO
What bacteria commonly causes refractory AOM? What has decreased the incidence of this?
S. pneumonia
Prevnar vaccine
What is the most common cause of bilateral AOM & conjunctivitis?
H. influenza
What bacteria most commonly causes mastoiditis?
Group A streptococcus
What are some of the symptoms AOM can cause?
Otalgia, fever, irritability, vomiting, and diarrhea
What if the child has a really high fever and you see red, swollen, irritated looking ear drum?
Keep looking… AOM will NOT cause a high-fever
Who needs to be treated with AOM?
Children under 2 with bilateral sxs
Children over 2 observe if minimal sxs and unilateral disease
So, how do you treat AOM?
NSAIDs, APAP, Auralgan drops if OLDER than 2, Amoxicillin HIGH DOSE
When do we use Amoxicillin/clavulanate?
If treated with Abx in the past months & if they also have conjunctivitis
What is sinusitis, and what is its normal course?
Viral infection – associated with the common cold
Usually resolves in 7-10 days – AKA NO ABX!!!
What is it called when sinusitis continues for longer than 10 days?
Acute bacterial rhinosinusitis – bacterial infection (give ABx)
How does a child present with sinusitis?
Cough, nasal sxs, HA, and possibly a fever
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?
Tx = Amoxicillin/clavulanate AKA Augmentin (high dose for more severe)
Prevent = preseptal cellulitis, orbital cellulitis, septic cavernous sinus thrombuosis, and meningitis.
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?
Roseola
How do you diagnose and treat?
Dx = clinical (often a rash presents on the 4th or 5th day), but often a diagnosis of exclusion
Tx = Supportive
What disease causes a low grade fever, HA, and rhinorrhea, along with a slapped cheek rash?
Fifth’s disease
What bacteria causes 5th’s disease?
Parvovirus B-19
If a child has 5th’s disease, who do they need to stay away from?
Immunosuppressed adults & preggo ladies
What are the 2 common pathogens of impetigo?
How do you treat it?
S. aureus & GAS
Tx = Topical mupirocin (must remove the crust first!) or Dicloxicillin
If a mother says that she thinks the child had a spider bite, what do you need to think of and r/o?
MRSA
What disorder causes a high fever in a child, with stridor, drooling and a sore throat?
Epiglottitis
What causes epiglottitis?
Haemophilus influenza type B
Is epiglottitis preventable?
YEP! Hib vaccine
If a child presents with a sore throat, myalgia, abdominal pain and no URI sxs – what diagnosis?
Strep pharyngitis
What causes strep pharyngitis?
Group A Streptococcus
How do you treat strep and what are you preventing?
Amoxicillin
Prevent peritonsillar abscess, mastoiditis, and rheumatic fever (does not prevent glomerulonephropathies)
If a patient has a hot potato voice with drooling and trismus (spasm of the neck muscles), what diagnosis?
pertonsillar abscess
What is the first virus to be associated with cancers in humans?
Epstein-Barr virus
What are some of the acute infectious sxs of EBV?
Malaise, HA, fever, exudative tonsillitis, with posterior cervical adenopathy
how do you diagnose EBV?
CBC with diff (shows atypical lymphocytes), Heterophile antibodies (mono spot), EBV specific serology
If we diagnose a kid with EBV, what must we do?
Take them out of contact sports = splenic rupture
What else can EBV cause (common in Africa)?
Burkitt lymphoma
What 3 diagnosis’s should you always have on your differential list when evaluating a febrile child??
Bacterial meningitis, Kawasaki’s disease, and UTI
How does Kawasaki’s disease present?
Fever x 5 days, conjunctivitis, mucositis (“strawberry tongue”), rash, and extremity changes (edema, erythema, desquamation)
What disease is highly contagious, spread via droplets which can remain airborne for hours, with a maculopapular rash, and koplik spots on buccal mucosa?
Measles
What disease is highly infectious and spreads rapidly in closed spaces via droplets and results in swelling of the parotid gland?
Mumps
What disease can be transmitted to the developing fetus and results in damaged blood vessels and ischemia in affected organs?
Rubella
How do we treat otitis externa?
Floroquinolone – Ofloxacin
Can add topical glucocorticoids to decrease inflammation
How do you treat mastoiditis?
Hospital admission with IV Abx
If a mother brings in a child due to their hoarse voice, what must you rule out?
Croup or parainfluenza virus
Otherwise rule out: tumors, trauma, endocrine, GERD, or congenital abnormalities
If a child has itchy, watery eyes, that are injected – what diagnosis? How do you treat it?
Allergic conjunctivitis
Treat with anti-histamine & cool compresses
Could also be viral (common in mid-summer to early fall)
If a child has red eyes that are stuck together with mucopurulent discharge – what diagnosis? How do you treat?
Bacterial conjunctivitis
Treat with floroquinolones
