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Pediatrics > HEENT > Flashcards

HEENT Flashcards

1
Q

Red Reflex

A

positive if inequality of color, intensity or clarity of the reflection, or the presence of opacities or whites spots

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2
Q

If red reflex positive…

A

Refer to opthamologist

  • Congenital cataract requires surgery before 3-4 months of age
  • Congenital cloudy cornea is considered an ophthalmic emergency–leads to vision loss.
  • due to glaucoma, trauma, scleroderma, dermoid cyst, infections, retinoblastoma, rhabdomyosarcoma
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3
Q

Strabismus

A
  • Coordinated movement of the eye develops by 3-6months, when infants begin using binocular vision
  • If deviation from coordinated movement persists beyond six months, refer for evaluation
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4
Q

Exotropia

A

eyes are divergent

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5
Q

Esotropia

A

Eyes are crossed

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6
Q

Causes of strabismus

A

Supranuclear (visual cortex)

Infranuclear (extraocular muscles or their respective nerves)

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7
Q

Complications of strabismus

A

Approx. 50% of children with strabismus under 9 years of age will develop amblyopia (loss of vision) in the eye if left untreated
Chronic strabismus can be disfiguring

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8
Q

Treatment of strabismus

A

Refer to opthlamologist

Correction of refractive errors, penalization of preferred eye by patching, and extraocular muscle surgery

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9
Q

Red eye/eye discharge questions

A

Unilateral or bilateral
Associated symptoms
Onset, spreading, location

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10
Q

Red eye with discharge: Dacrostenosis

A

-Stricture of the nasolacrimal duct, often resulting from a congenital abnormality. Presents between ages 3-12 weeks as a persistent tearing of one eye

Self-limiting: resolves by 6 months

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11
Q

Red eye with discharge: Dacrocystitis

A

infection of the lacrimal sac, secondary to dacrostenosis. Sxs: pain, erythema and edema about the lacrimal sac; tearing and conjunctivitis

Tx: warm compress, milk the contents of the lacrimal sac
OR the punctum can be dilated and the nasolacrimal canal probed

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12
Q

Bacterial conjunctivitis

A

Usually staph
Injection of conjunctiva, tearing, mucopurulent discharge, swelling of eyelid
unilateral, but may spread to other eye
TX: Warm compresses, herbal eye wash, topical antibiotics

(if mom is breastfeeding…breast milk!)

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13
Q

Viral conjunctivitis

A

Associated with URI
Watery clear discharge, minimal lid swelling
bilateral
TX: Warm compresses, herbal eye wash

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14
Q

Allergic conjunctivitis

A

Environmental factors
Clear, mucoid, ropy discharge, moderate to severe lid edema, itchy
bilateral
TX: Treat allergies, modify environment

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15
Q

Periorbital Cellulitis

A

involves the eyelid and surrounding skin
sxs: edema and erythema of upper and lower eyelid, usually unilateral; fever; pain
TX: IV abx, outpt if parents compliant

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16
Q

Orbital cellulitis

A

periorbital and orbital contents
cause: 1. Breach of skin-bug bite, trauma; s aureus, s pyogenes
2. Internal infections-sinusitis, bacteremia; h. influenza type b or strep pneumoniae
sxs: eyeball becomes swollen and bulges, decreased ability to move eye, decrease vision
TX: EMERGENT. IV Abx

17
Q

Complications of peri/orbital cellulitis

A
  1. Retinal damage secondary to ischemia

2. Meningitis, brain abscess

18
Q

Blepharitis

A

Inflammation of the lid margins with erythema, thickening and crusts, scales or shallow marginal ulcers; may see loss of lashes
TX: daily cleansing with baby shampoo; antibiotic ointment or herbal eyewash for infection as needed; homeopathy
(herbal eyewash: sterile eye saline with calendula, echinacea, goldenseal, eye bright; 3-4 drops of each herb in __oz tincture bottle)

19
Q

Hordeolum (Stye)

A

Acute localized, pyogenic infection of one or more of the glands of Zeis or Moll or of the meibomian glands generally caused by staph
internal or external

sxs: pain, redness and tenderness; may find small, tender area of induration

TX-hot packs 10 min TID to QID; homeopathy; (antibiotics rarely if ever indicated)

20
Q

Rhinitis TX

A

Remove envl and dietary cause

Clean windowsills, run humidifier, avoid food sensitivities, vitamin C, bioflavinoids, herbs.

[If allergic–wash hands and face frequently!! Sleep with bedroom window closed, air purifier]

Immune glycerin by WWH

21
Q

Sinusitis

A

bacterial causes include strep, pneumococci, hemophilus, or staph species (but can be viral, allergic)
Hx: recent URI with a late onset fever.
Tx: 1/2 self-limited; saline rinses, humidifier, steam, compresses. Mucolytic- water and NAC.
Glycerite herbs with added amoracia, mahonia. Wet socks. Abx: amoxicillin 40 mg/kg in 3 divided doses. [augmentin if you suspect h. influenza]

22
Q

Sore throats- common viruses

A

adenovirus, influenza, parainfluenza, rhinovirus, RSV
Sxs: Coryza, conjunctivitis, malaise, hoarseness, low-grade fever suggest viral pharyngitis. [mouth-breathing, vomiting, abdominal pain and diarrhea]

23
Q

Coxsackie viruses

Hand, foot, and mouth

A

small red papules, vesicles and ulcers on tongue, buccal mucosa, palate, gingival and uvulotonsillar pillars. Often see 2-10 lesions that persist one week

24
Q

Herpangina

A

small red papules, vesicles and ulcers on posterior oropharynx. High fever common.
due to Coxsackie virus
VERY painful, consider topical lidocaine

25
Q

Mononucleosis

A

Pharyngeal injection with exudates, posterior cervical lymphadenopathy, hepatosplenomegaly.
>15 yrs

26
Q

Bacterial sore throat:

Group A beta hemolytic strep

A

Sxs: mod to several pharyngeal erythema, edema and tonsillar enlargement; exudate in crypts of tonsils, cervical lymphadenopathy, palatine petechiae
TX: Oral Pen V, amoxicillin, cephalosporins, erythromycin
BEMP Tincture, hydrotherapy, homeopathy
Children on antibiotics can return to school after 24 hours of treatment
No need to reculture; watch for suppurative complications

27
Q

Strep throat sequalae: Scarlet Fever

A

sandpaper rash due to hypersensitivity to strep pyrogenic toxin. Begins on trunk and spreads over body. Rash blanches with pressure and desquamates after 7-21 days.

28
Q

Strep throat sequalae: Acute post-infectious glomerulonephritis

A

from the antibodies!

29
Q

Strep throat sequalae: Rheumatic Fever

A

Should be suspected in any patient with joint swelling, subcutaneous nodules, erythema marginatum or heart murmur, with concomitant strep within the past month.

30
Q

Strep throat sequalae: peritonisilla abscess

A

Results from accumulation of purulence in the tonsilar fossa. Peritonsilar edema may lead to compromise of the upper airway.
PE: unilateral peritonsilar fullness/bulging of the posterior, superior soft palate with uvular deviation.
Refer immediately for drainage of abscess and IV antibiotics

31
Q

Strep throat sequalae: Retropharyngeal abscess

A

Abscess occurs subsequent to lymph drainage or localized spread of bacteria. Sxs: sore throat, fever, neck pain or stiffness, poor oral intake. PE: exam will also reveal neck mass or retropharyngeal bulge. Refer immediately!!

32
Q

Epiglottitis

A

Bacteria are H. influenza, staph and strep.
History: abrupt onset of high fever, sore throat without URI symptoms.
Child appears TOXIC
PE: anxious child with chin hyperextended, drooling, slow and labored respiratory effort with stridor and retractions. DO NOT examine pharynx
Refer to ER with oxygen

33
Q

Acute purulent otitis media

A

Abx for children under 2 yrs
otherwise watch and wait, garlic and mullein
Homeopathy: belladonna, chamomilla, pulsatilla, kali bic, aconite, calc carb

34
Q

Otitis media with effusion

A

TM clear, amber or gray, retracted. May see fluid line or bubbles.
May lead to hearing loss
Early treatment with antibiotics.
Identify food sensitivities, environmental sensitivities, decrease inflammation, endonasal treatments
complication from OM

35
Q

Indications for tympanostomy

A

hearing loss, speech delays, concomitant infections or infections (tonsillitis, enlarged adenoids, snoring, frequent severe URIs, apnea)

36
Q

Complications of OM

A
  1. Mastoiditis-fever, OM and post-auricular swelling and tenderness (ear lifts away from head). Refer to ER for IV antibiotics.
  2. Delayed speech development, hearing loss
  3. Chronic perforation can require surgery
  4. Tympanosclerosis-generally not a problem unless it involves the entire TM
  5. Cholesteatoma-appears as a white lesions behind the TM
  6. Meningitis, brain abscess, subdural empyema, and epidural abscess
37
Q

Chronic serous OM

A

aka mucoid aka glue ear
wrinkled/retracted appearance, no bony landmarks; chronic fluid/bubbles behind ear, amber TM
Management: tx eustachian tube dysfunction, tx allergies, refer to chiropractor/craniosacral
J tug on ear lobe; downward massage on posterior SCM

Pediatrics (12 decks)

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