HEENT Flashcards
1
Q
Vision acuity at 5 years
A
20/30
2
Q
Hyperopia
A
Cannot see near things
3
Q
Myopia
A
Cannot see far things
4
Q
Amblyopia
A
Loss of vision in the eye due to failure of the retina to develop.
5
Q
Amblyopia treatment
A
Patch the good eye
6
Q
Amblyopia types
A
deprivation, strabismic, anisometropic
7
Q
curved cornea, pain, headache and reading problems and blurry vision
A
Astigmatism
8
Q
Amaurosis
A
blindness
9
Q
Legal blindness criteria
A
20/200
10
Q
First clues of blindness
A
retinopathy, nystagmus
11
Q
Eye deviating inward
A
esotropic
12
Q
Eye deviating outward
A
Exotropic
13
Q
Eye deviating upward
A
hypertropia (refer immediately)
14
Q
Eye deviating downward
A
Hypotropia (refer immediately)
15
Q
Epicanthal fold in asians
A
pseudo strabismus
16
Q
Test for strabismus
A
cover test, corneal light reflex/hirschberg test, EOMS
17
Q
Referable eye issues
A
asymmetric red light reflex
asymmetric corneal light reflex
abnormal cover/uncover test
2 line difference in scoring eyes
18
Q
Most common causes of conjunctivitis
A
Staph, strep, h influenza
19
Q
Common cause of viral conjuncitivitis
A
adeno virus, hsv, varicella
20
Q
purulent discharge with chemosis in newborn 2-4 days old
A
gonococcal conjuncitivitis
21
Q
mild mucopurulent discharge with pneumonia in newborn
A
chlamydia conjunctivitis
22
Q
signs and symptoms of conjunctivitis
A
itchy eye, foreign body sensation, tearing, purulent discharge, eyelid edema, chemosis
23
Q
conjuncitivitis general treatment
A
Tobramycin topical
24
Q
When to refer conjunctivitis
A
Refer if not responsive to topical antibiotics in 2-3 days, loss of vision, ciliary injection, eye pain
25
Dacryostenosis cause and treatment
blocked tear ducts, treat by massage. Refer if not better than 1 year
26
Obstruction and inflammation of meibomian gland in the posterior margins or upper or low lid
Chalazion
27
Nodular non tender cyst on palpebral surface of eye lid
Chalazion
28
Chalazion treatment
warm soaks. Does not need antibiotics
29
Acute localized inflammation of one or more sebaceous gland
Hordeolum (stye)
30
Sudden onset of tenderness, redness, and swelling of affected eye lid, foreign body sensation, PAIN on palpation
Hordeolum (stye)
31
Hordeolum (stye) treatment
bacitracin/ erythromycin opthalmic
32
Poor visual fixation, photophobia, decreased visual acuity, black dots in red reflex
Cataracts
33
Inflammation and crusting at eyelid margins
blepharitis
34
blepharitis common bacterial cause
staph
35
blepharitis treatment
warm compress, wash with baby shampoo
36
Photophobia, abnormal overflow of tears, blepharospasm
Glaucoma
37
Decreased vision in tunnel fashion
Glaucoma
38
developmental anomalies assc with glaucoma
marfans, pierre robin, congenital rubella syndrome, neurofibromatosis
39
Involuntary, horizontal, vertical, rotary or mixed eye movements
nystagmus
40
Nystagmus treatment for PNP
Refer to optho
41
Squinting, eyes turn outward more than inward, painful red eye, hyphema, creamy pink mass on fundoscopic exam
Retinoblastoma
42
Opthalmoplegia (paralysis of eye muscle) and proptosis (protrusion of eyeball)
Orbital cellulitis
43
lid edema, proptosis, decreased ocular mobility and decreased acuity. EOMIs not in tact
Orbital cellulitis
44
Accumulation of blood in the anterior chamber of the eye as a result of blunt trauma
hyphema
45
Hyphema treatment
```
refer
bed rest
HOB elevated
Shield it, do not patch
no asa/reading
```
46
Anisometropia definition
> 2 line difference in the visual acuity of a child between 0-7
47
deviation of eye in all fields of gaze
comitant strabismus
48
limited eye movement and size of deviation is different in all fields of gaze
incomitant strabismus
49
crossing of the eye that becomes apparent only on alternating the cover test on the eyes.
Latent strabismus. (term used is phoria. e.g. exophoria)
50
Sensation of foreign body, pain, photophobia, tearing, belpharospasm, dec vision + fluoresein staining
corneal abrasion
51
corneal abrasion treatment
rest, topical antibiotics, oral analgesics, refer if severe injury
52
Flashing light sensation
retinal detachment
53
retinal detachment treatment
refer immediately to optho
54
Blurry vision that is progessively getting worse.
Dark cloud in visual field
Floaters.flashing lights
Darkening on retinal vessels on fundoscopy
Hematoma/contussion of orbit
55
Hematoma/contussion of orbit treatment
immediate referal to optho
56
trauma, pain, diplopia, numbness below orbit, facial bruising, globe displacement, swelling, hyphema, absent red light reflex, corneal abrasion
orbital fracture
57
orbital fracture work up
plain film radiography
| ct
58
Orbital fracture tx
immediate referral to optho
59
Normal size tonsils in child between 6-8
+3/+4
60
Chronic hoarse voice in child
consider vocal polyp
61
Inflammation of the mucosa lining the structures of the throat including the tonsils, pharynx, uvula, soft palate, and nasopharynx
Pharyngitis
62
Most common cause of nasopharyngitis
Adenovrius
63
Acute onset of sore throat with headache, nausea, vomiting, abdominal pain in the winter and spring
GABHS
64
ASO-what it's used for
to detect past infections of strep and rises 1 week post infection. Peaks 3 to 6 weeks after infection
65
GABHS treatment of choice
```
Penicillin V potassium.
Kids <27 kg 250 mg bid for 10 days
Kids >27 kg 500 mg bid for 10 days
May give amox
Benzathine pen g IM
If allergic give cephalexin 20 mg/kg
Clinda
Azithromycin
```
66
GABHS transmission
Fomites like bathroom cups, toothbrushes, or orthodonic devices
67
When can kids return to school after GABHS
afebrile and have been taking antibiotics for 24 hours min
68
Tx of chronic GABHS
Clindamycin 20-30 mg/kg/day tid for 10 days
| Amox-clauv 40 mg/kg/day
69
Complications of late GABHS
rheumatic fever, joint pain, glomerulnephritis
70
PANDAS diagnostic criteria
Obsessive compulsive disorder
Onset of diseas emust be prepubertal
Abrupt onset with symptom course that is relapsing and remitting
Clear assc w GABHS
Neuro abnormalities like motor hyperactivity
71
JONES criteria
```
Joint pain
Myocarditis
Subcu skin nodules
Erythema marginatum
Sydenham chorea
```
72
```
Inability to open jaw
High fever
Sore throat
Prominence of tonsillar pillar on affected side
Bad breath
```
Peritonsillar abcess
73
Epiglottitis patho and causitive organism
Inflammation of the epiglottis, the aryepiglottic folds and ventricular bands. Caused by haemophilus influenzae type b.
74
Abrupt fever, severe sore throat, dyspnea, inspiratory distress without stridor, and drooling
Kid looks acutely ill and toxic
Epiglottitis
75
Epiglottitis diagnostic studies
Blood culture
| Lateral neck radiograph
76
Thumb sign on radiograph
Epiglottitis.
77
Epiglottitis treatment
Get patient to hospital asap
Have pt be examined by otolaryngologist
Admin broad spectrum IV antibiotics
Admin oxygen and respiratory support
78
Epiglottitis prophylaxis
Rifampin 20 mg/kg should be given to all household contacts if in the home there is a kid younger than 4 w no vaccines, immunocompromised person, kids less than 1 w no HIB vaccine
79
Acute Otitis media 2nd common organism
Strep pneumoniae
80
Acute Otitis media #1 most common organism
H influenza
81
Acute Otitis in a child <1 month old tx
Refer to ED
| Check for bacteremia
82
Acute Otitis in a child <2 years old
treat most cases for 10 days with high dose amoxil
83
Acute Otitis in a kid > 2 years old with no frequent AOM
Consider watchful waiting for 2-3 days. If need to treat give high dose amoxil for max 5 days
84
Acute Otitis in a kid >2 years who received antibiotics a month prior
Watchful waiting for 2-3 days. If tx give high dose amoxil/clav for max of 5 days
85
Acute Otitis in a kid of any age with frequent AOM
verify AOM vs OME if AOM tx with high dose amoxil/clav for 10 days. Consider prevnar if <5
86
Treatment of choice for pain relief in AOM
acetaminophen is #1 but can give ibuprofen
87
When to refer AOM
greater than 3 episodes in 6 months or 4 episodes in 1 year
| kids w middle ear fluid lasting longer than 3 months
88
When to order tympanotomy tubes
Chronic OME that lasts longer than 3 months with hearing loss. Recurrent AOM >3 episodes in 6 months or >4 episodes a year
89
When to watch and wait for AOM
```
>2 years old
Mild or unilateral AOM
No toxicity or sever pain
Late presentation > 36 hours
No otorrhea
No hx of chronic OM
Available for f/u
```
90
Inflammation of the nasal passages that can last up to 4 weeks
Rhinosinusitis
91
URI with persistent nasal discharge or daytime cough lasting 10 days without improvement
Rhinosinusitis
92
URI who develops woresening or new onset of fever, nasal discharge, or daytime cough after initial improvement
Rhinosinusitis
93
fever > 102.2 or 39 with purulent nasal discharge for at least 3 days who also has sinusitits
Rhinosinusitis
94
Chronic Rhinosinusitis
> 12 weeks
95
High fever w purulent nasal discharge in which child experiences worsening of symptoms after initial symptoms of recovering from URI "double sickening"
sinusitis
96
Facial pain or nasal congestion or fullness, nasal discharge, purulence, or discolored post nasal drip, fever, or anosmia (loss of smell)
sinusitis
97
HA, halitosis (bad breath) faitgue, dental pain, cough, ear pain, pressure, or fullness
sinusitis
98
What not to do for sinusitits
Transillumination and percussion.
99
Diagnostic for sinusitis
Imaging not needed--clinical diagnosis
100
Treatment of sinusitits
Severe onset=anitibiotics
Complication w rhinosinusitits=antibiotics or watchful waiting for 3 days
Pain relief w acetaminophen or ibuprofen
101
Antibiotic for sinusitis
Amox w or w.o clav for 10-14 days. Reassess if you tx with antibiotics or not in 3 days.
102
What not to give for sinusitits
Decongestants and antihistamines, topical corticosteroids
| May give saline but no guidelines supporing
103
What activity not to do with sinusitis
Diving
104
Common complication with sinusitits in kid under 5y
Orbital inflammation and infection
105
Pott's puffy tumor--what is it?
Osteomyelitis of the frontal bone and neurosurgical consult should be obtained. A potential complication of sinusitis
106
What do you need to do if there's a complication with sinusitis
referral to otolaryngologist and infectious disease
107
What to order if you suspect a coagulopathy in a nosebleed?
CBC, PT, PTT, platelet count, If labs are normal consider von willebrand disease workup
108
Persistent or recurrent unilateral purulent nasal discharge that is foul. Possible epistaxis, nasal obstruction, and mouth breathing
Nasal foreign body
109
What you must consider if there are nasal polyps
CF
110
When are polyps usually seen?
In kids with allergies
111
Treatment for nasal polyps
1. Nasal steroid first line
2. Anihistamine
3. Astelin (topical anihistamine)
4. Cromolyn
112
Midline neck mass that moves when tongue protrudes
Thyroglossal duct cyst
113
A solitary, painless mass in the neck. Smooth, nontender, fluctuant masses, which occur along the lower one third of the anteromedial border of the sternocleidomastoid muscle between the muscle and the overlying skin.
Brancial cleft cyst
114
Cervical adenitis
infection of lymph nodes
115
When to refer a kid with a chalazion for excision?
when there is lid lag
116
Age that you need to treat strabismus by to prevent ambylopia
7, but can go up to 12
117
Causitive agents of sinusitis
Strep pneumo, m cat or h flu
118
Chronic sinusitis
> 30 days
119
Acute sinusitis
> 10 days
120
Symptoms of bacterial pharyngitis
```
High fever
Malaise
Sore throat
n/v, ha, petechiae
tonsillar exudate, swollen lymph
```
121
Bacterial pharyngitis treatment
Penicillin or amoxicillin
122
High fever, drooling, tripod sitting, muffled voice, toxic,
epiglottitis
123
fever, drooling, muffled voice, halitosis, unilateral tonsillar swelling, uvula displacement from affected side
peritonsillar abscess
124
Peritonsillar abscess treatment
Immediate referall to ED. Need I&D and antibiotics
125
High fever, severe sore throat, drooling, hyperextension of head, toxic appearing, stridor, prominent swelling of post pharynx wall
Retropharyngeal abscess
126
Retropharyngeal abscess treatment
Immediate referral to ED
127
Allergic rhinitis patho
IgE mediated response to allergens, causing nasal mucosa inflammation
128
Sensorineural hearing--loss what is it
damage to the cochlea/auditory nerve
129
Cause of sensorineural hearing loss
noise, menigitis, hyperbili, kernicterus, gentamycin, lbw, measels, mumps, rubella, intracranial hemorrhage
130
High frequency hearing loss
sensorineural
131
Low frequency hearing loss
conductive hearing loss
132
Cause of conductive hearing loss
OME, AOM, cerumen, FB, perf TM, cholesteatoma
133
An abnormal white reflection from the retina of the eye
Leukokoria
134
Glaucoma treatment
surgery, beta blockers
135
Cataracts treatment
surgical removal of the lens with use of corrective lens, possible watch and wait
136
Management of strabismus
occlude/path the good eye
137
Acute infection /inflammation of the external auditory canal
swimmer's ear aka otitis externa
138
Otitis externa bacterial agents
pseudomonas and staph,
139
Otitis externa s+s
itching outter ear, pain when moving tragus, swollen EAC. Fullness in the ear + black spots on tm if fungal
140
Otitis externa tx
analgesics, otic antibiotic drops (cipro/mycotic drops)
141
External cyst of middle ear that is congenital or acquired
Cholesteatoma
