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Clinical Disciplines II > HEENT > Flashcards

HEENT Flashcards

1
Q

Bacterial conjunctivitis: signs

A
  • thick, purulent, ropy discharge
  • unilateral
  • eyelids “crusted shut”
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2
Q

Bacterial conjunctivitis: pathogen

A

newborns: Chlamydia trachomatis
children: Strep pneumo, H. influenza, S. aureus

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3
Q

Bacterial conjunctivitis: treatment

A

infants: antibiotic ointment
older children: antibiotic drops

**treat both eyes

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4
Q

Viral conjunctivitis: pathogen

A

adenovirus

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5
Q

Viral conjunctivitis: presentation

A
  • bilateral
  • injected conjunctiva
  • watery discharge
  • feels “gritty”
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6
Q

Viral conjunctivitis: treatment

A

self-limited

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7
Q

Allergic conjunctivitis: presentation

A
  • VERY itchy**, watery, red eyes
  • Profuse watery discharge/tearing
  • Typically with allergic rhinitis symptoms
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8
Q

Allergic conjunctivitis: treatment

A

olopatadine in children over 2

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9
Q

Periorbital cellulitis: presentation

A
  • anterior to orbital septum
  • mild, minimal complications
  • erythematous and edematous eyelids, pain and mild fever
  • Vision and EOMs are normal
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10
Q

Periorbital cellulitis: pathogen

A

S. aureus and Strep. pyogenes

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11
Q

Periorbital cellulitis: treatment

A

oral antibiotics

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12
Q

Orbital cellulitis: general

A
  • infection posterior to the orbital septum
  • Almost always associated with sinus infection
  • Staph or Strep
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13
Q

Orbital cellulitis: presentation

A
  • Pain with EOMs
  • Proptosis**
  • fever
  • lid swelling and erythema
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14
Q

Orbital cellulitis: Tx

A
  1. Emergent opthalmology consult

2. IV antibiotics

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15
Q

Kawasaki disease: general

A

systemic inflammation of medium and small arteries

  • *leading cause of acquired heart disease in children in the US**
  • More common in asian boys <5 years
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16
Q

Kawasaki disease: diagnostic criteria

A
  1. Conjunctivitis (bilateral, bright red, non exudative)
  2. Mucositis (cracked lips, strawberry tongue**, pharyngeal erythema)
  3. Rash (starts in perineum, skin peels, then spreads)
  4. Lymphadenopathy (cervical - least consistent symptom)
  5. Extremity changes (edema, redness of palms/soles
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17
Q

Kawaski disease: treatment

A

IVIG + ASA

-obtain baseline echocardiogram (repeat in 2 and 6 wks)

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18
Q

Kawasaki disease: complications

A

coronary artery aneuryms

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19
Q

Corneal abrasion: signs and symptoms

A
  • Severe ocular pain**
  • blephorospasm (tight closure of the eye)
  • Rubbing at eye
  • Photophobia
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20
Q

Corneal abrasion: diagnosis

A

fluorescein stain w/ Wood’s Lamp

if foreign body –>refer

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21
Q

Corneal abrasion: tx

A

Erythromycin ointment and recheck in 24-48 hours

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22
Q

Dacryostenosis: general

A
  • nasolacrimal duct obstruction
  • MC cause of persistent tearing and eye discharge in infants and children
  • palpable nasolacrimal sac
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23
Q

Dacryostenosis: treatment

A
  • lacrimal sac massage in downward direction 2-3x day

- refer if no resolution in 6 months

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24
Q

Dacryocystitis: general

A

-nasolacrimal duct obstruction

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25
Q

Dacryocystitis: treatment

A

mild: oral antibiotics
severe: IV antibiotics (after culture and staining)

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26
Q

Acute otitis Media: signs and symptoms

A
  • Fever
  • ear pain
  • headache
  • decreased hearing
  • Usually follow URI**

Infant: poor feeding, pulling at ear, batting at head, poor sleep

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27
Q

Acute otitis media: physical exam

A
  • red bulging ear drum

- middle ear effusion

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28
Q

Who do you treat right away with antibiotics for AOM?

A
  1. Children <6months
  2. Children 6months-2 years if bilateral
  3. If severe: Children >2 years if they appear toxic, or otalgia for more than 2 days,, fever >102.2
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29
Q

IF your patient is over 2 years, healthy, has unilateral otitis media with mild symptoms what should you do?

A

observe for 48 hours

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30
Q

Acute otitis media: tx

A

Amoxicillin for 10 days

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31
Q

When do you refer to ENT?

A

if >4 episodes a year of acute otitis media or possible hearing problems

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32
Q

Otitis media with PE tubes in the TM: Treatment

A

fluroquinolone drops

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33
Q

Serous otitis media

A
  • middle ear fluid build up but no infection
  • TM is immobile*
  • Bubbles/fluid level may be visible
34
Q

Serous otitis media: treatment

A
  • self limited (can take up to 12 weeks)

- if longer –> ENT

35
Q

Otitis externa

A

-unilateral
-malodorous discharge
-trageal tenderness
Tx: antibiotic drops like poly myxin B. Fluroquinolone drop if TM perf

36
Q

Otitis externa: prevention

A

50/50 rubbing alcohol with white vinegar after swimming

37
Q

Nasal foreign body

A

congestion

-foul smelling

38
Q

Aural foreign body

A

Tx: attempt irrigation first if TM is intact

39
Q

Which two sinuses are present at birth and which two develop later?

A

Ethmoid and maxillary —>at birth

Frontal–> 5-7 yr

Sphenoid–> 9 yr

40
Q

Sinusitis: Signs and symptoms

A

> 10-14 days without improvement**

-consider CF if recurrent sinus infections

41
Q

Sinusitis: pathogen

A

S. pneumoniae

42
Q

Sinusitis; dx

A

water’s view radiograph

43
Q

Sinusitis: tx

A

Amoxicillin-clavulanate (Augmentin) BID

44
Q

Pharyngitis: cause

A

viral

45
Q

Pharyngitis: S/S

A
  • red throat
  • congestion
  • swollen cervical lymph nodes
  • Bilateral conjunctivitis (adenovirus)
46
Q

EBV: general

A

more common in adolescents

  • exudative tonsilitis
  • cervical lymphadenopathy
  • splenomegaly
  • incubation period 4-8 wks
47
Q

EBV: dx

A

fingerstick (Monospot)

EBV titers

48
Q

EBV: treatment

A

AVOID contact sports for fear of rupture of the spleen (6-8 wks)

49
Q

Group A Beta Hemolytic Strep: cause

A

Strep pyogenes

50
Q

Group A Beta Hemolytic Strep: symptoms

A

If >3yrs:

  • sore throat
  • headache*
  • nausea*
  • rash*

If <3 yrs:

  • nasal congestion
  • low grade fever
  • anterior cervical lymphadenopathy
51
Q

Group A Beta hemolytic strep: physical exam

A
  • exudative tonsillitis
  • anterior cervical lymphadenopathy
  • palatal petechiae*
  • halitosis
  • coated tongue
52
Q

Group A Beta Hemolytic Strep: diagnosis

A
  1. Rapid strep antigen test (swab)

if swab is negative do culture

  1. Throat culture (“gold standard”)
53
Q

Group A Beta Hemolytic Strep: treatment

A

Penicilllin VK BID for 10 days
[tastes baddd]

Amoxicillin BID for 10 days

If PCN allergy –>cephalexin

54
Q

Acute Rheumatic fever (post strep): signs and symptoms

A

Jones Criteria
Major:
1. Migrating polyarthritis of the large joints
2. Carditis/valvulitis
3. Chorea
4. Erythema marginatum (not itchy, spares face)
5. Subcutaneous nodules (nonpainful)

Minor:

  1. Arthralgia
  2. Fever
  3. ESR elevated
  4. Prolonged PR interval
55
Q

How many major and minor criteria are needed from the Jones criteria to dx Acute rheumatic fever?

A

2 major

or

1 major + 2 minor

56
Q

Group A beta hemolytic strep: dx

A

ASO titers

57
Q

Group A beta hemolytic strep: tx

A

Amoxicillin
ASA
Evaluate for CHF, cardiomegaly

58
Q

Post streptococcal Glomerulonephritis: S/Sx

A
  1. Edema
  2. Hematuria (tea-colored urine)
  3. Proteinuria
  4. HTN
59
Q

Peritonsillar abscess

A
  • S. pyogenes
  • older kids and adolescents
  • difficulty/pain with swallowing
  • muffled “hot potato” voice**
60
Q

Peritonsillar abcess: diagnosis

A
  • deviated uvula
  • CT with contrast
  • Aspiration
61
Q

Peritonsillar abscess: Tx

A

AIRWAY

-incision and drainage

62
Q

Coxsackie virus

A

“hand, foot and mouth disease”

S/Sx:

  • oral lesions “herpangina” on tongue
  • rash on hands and feet
  • Usually under 5 years
63
Q

Coxsackie virus: signs and symptoms

A
  • Refusal to eat or drink, drooling
  • sore throat
  • headache
  • low grade fever
64
Q

Coxsackie virus: tx

A

supportive

65
Q

Herpetic Gingivostomatitis

A
  • HSV-1 infection

- ulcerative lesions of the gingiva and mucous membranes

66
Q

Herpetic gingivostomatitis: signs and symptoms

A
  • ulcerated lesions bleed if disturbed**

- 3-4 day prodrome

67
Q

Herpetic gingivostomatitis: tx

A
  • oral acyclovir (if had for fewer than 4 days
  • NSAIDs/acetaminophen
  • Hydration
68
Q

Measles: Prodrome symptoms

A
  • Koplik spots** (whitish elevations on an erythematous base opposite the molars (2 days before rash)
  • conjunctivitis, coryza and cough
69
Q

Measles: rash

A

-Maculopapular, blanching rash begins on face spreads to neck, trunk, extremitis

70
Q

Measles: Dx

A

IgM assay

71
Q

Mumps: S/sx

A

Unilateral, swelling and tenderness of the parotid gland

  • Orchitis (fever, testicular pain, swelling)
  • Oophoritis (females)
72
Q

Mumps: TX

A

supportive

73
Q

Rubella: signs and symptoms

A

fever with post auricular and occipital adenopathy

-Rash starts on face spreads over 24 hours, disappears within 3 days

74
Q

Congenital Rubella syndrome

A
  • hearing loss, mental retardation, CV defects, ocular defects
  • Purpuric “blueberry muffin” rash at birth
  • jaundice, thrombocytopenia, deafness
75
Q

Candidiasis (diaper)

A

“beefy red” with satellite lesions

  • candida albicans
  • involves skin folds
76
Q

Candidiasis: tx

A

AVOID steroids!

-topical clotrimazole

77
Q

Cradle cap

A
  • seborrheic dermatitis

- greasy, yellowish scales on scalp

78
Q

Cradle cap: tx

A
  1. Apply emollient (ex. petroleum jelly)

2. Use soft baby-brush

79
Q

Impetigo

A
  • staph aureus

- “honey colored crusts”on face or extremities

80
Q

Impetigo: tx

A

mupirocin topical antibiotic for 3-5 days

Clinical Disciplines II (15 decks)

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