HEENT Flashcards
Bacterial conjunctivitis: signs
- thick, purulent, ropy discharge
- unilateral
- eyelids “crusted shut”
Bacterial conjunctivitis: pathogen
newborns: Chlamydia trachomatis
children: Strep pneumo, H. influenza, S. aureus
Bacterial conjunctivitis: treatment
infants: antibiotic ointment
older children: antibiotic drops
**treat both eyes
Viral conjunctivitis: pathogen
adenovirus
Viral conjunctivitis: presentation
- bilateral
- injected conjunctiva
- watery discharge
- feels “gritty”
Viral conjunctivitis: treatment
self-limited
Allergic conjunctivitis: presentation
- VERY itchy**, watery, red eyes
- Profuse watery discharge/tearing
- Typically with allergic rhinitis symptoms
Allergic conjunctivitis: treatment
olopatadine in children over 2
Periorbital cellulitis: presentation
- anterior to orbital septum
- mild, minimal complications
- erythematous and edematous eyelids, pain and mild fever
- Vision and EOMs are normal
Periorbital cellulitis: pathogen
S. aureus and Strep. pyogenes
Periorbital cellulitis: treatment
oral antibiotics
Orbital cellulitis: general
- infection posterior to the orbital septum
- Almost always associated with sinus infection
- Staph or Strep
Orbital cellulitis: presentation
- Pain with EOMs
- Proptosis**
- fever
- lid swelling and erythema
Orbital cellulitis: Tx
- Emergent opthalmology consult
2. IV antibiotics
Kawasaki disease: general
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
Kawasaki disease: diagnostic criteria
- Conjunctivitis (bilateral, bright red, non exudative)
- Mucositis (cracked lips, strawberry tongue**, pharyngeal erythema)
- Rash (starts in perineum, skin peels, then spreads)
- Lymphadenopathy (cervical - least consistent symptom)
- Extremity changes (edema, redness of palms/soles
Kawaski disease: treatment
IVIG + ASA
-obtain baseline echocardiogram (repeat in 2 and 6 wks)
Kawasaki disease: complications
coronary artery aneuryms
Corneal abrasion: signs and symptoms
- Severe ocular pain**
- blephorospasm (tight closure of the eye)
- Rubbing at eye
- Photophobia
Corneal abrasion: diagnosis
fluorescein stain w/ Wood’s Lamp
if foreign body –>refer
Corneal abrasion: tx
Erythromycin ointment and recheck in 24-48 hours
Dacryostenosis: general
- nasolacrimal duct obstruction
- MC cause of persistent tearing and eye discharge in infants and children
- palpable nasolacrimal sac
Dacryostenosis: treatment
- lacrimal sac massage in downward direction 2-3x day
- refer if no resolution in 6 months
Dacryocystitis: general
-nasolacrimal duct obstruction
Dacryocystitis: treatment
mild: oral antibiotics
severe: IV antibiotics (after culture and staining)
Acute otitis Media: signs and symptoms
- Fever
- ear pain
- headache
- decreased hearing
- Usually follow URI**
Infant: poor feeding, pulling at ear, batting at head, poor sleep
Acute otitis media: physical exam
- red bulging ear drum
- middle ear effusion
Who do you treat right away with antibiotics for AOM?
- Children <6months
- Children 6months-2 years if bilateral
- If severe: Children >2 years if they appear toxic, or otalgia for more than 2 days,, fever >102.2
IF your patient is over 2 years, healthy, has unilateral otitis media with mild symptoms what should you do?
observe for 48 hours
Acute otitis media: tx
Amoxicillin for 10 days
When do you refer to ENT?
if >4 episodes a year of acute otitis media or possible hearing problems
Otitis media with PE tubes in the TM: Treatment
fluroquinolone drops
Serous otitis media
- middle ear fluid build up but no infection
- TM is immobile*
- Bubbles/fluid level may be visible
Serous otitis media: treatment
- self limited (can take up to 12 weeks)
- if longer –> ENT
Otitis externa
-unilateral
-malodorous discharge
-trageal tenderness
Tx: antibiotic drops like poly myxin B. Fluroquinolone drop if TM perf
Otitis externa: prevention
50/50 rubbing alcohol with white vinegar after swimming
Nasal foreign body
congestion
-foul smelling
Aural foreign body
Tx: attempt irrigation first if TM is intact
Which two sinuses are present at birth and which two develop later?
Ethmoid and maxillary —>at birth
Frontal–> 5-7 yr
Sphenoid–> 9 yr
Sinusitis: Signs and symptoms
> 10-14 days without improvement**
-consider CF if recurrent sinus infections
Sinusitis: pathogen
S. pneumoniae
Sinusitis; dx
water’s view radiograph
Sinusitis: tx
Amoxicillin-clavulanate (Augmentin) BID
Pharyngitis: cause
viral
Pharyngitis: S/S
- red throat
- congestion
- swollen cervical lymph nodes
- Bilateral conjunctivitis (adenovirus)
EBV: general
more common in adolescents
- exudative tonsilitis
- cervical lymphadenopathy
- splenomegaly
- incubation period 4-8 wks
EBV: dx
fingerstick (Monospot)
EBV titers
EBV: treatment
AVOID contact sports for fear of rupture of the spleen (6-8 wks)
Group A Beta Hemolytic Strep: cause
Strep pyogenes
Group A Beta Hemolytic Strep: symptoms
If >3yrs:
- sore throat
- headache*
- nausea*
- rash*
If <3 yrs:
- nasal congestion
- low grade fever
- anterior cervical lymphadenopathy
Group A Beta hemolytic strep: physical exam
- exudative tonsillitis
- anterior cervical lymphadenopathy
- palatal petechiae*
- halitosis
- coated tongue
Group A Beta Hemolytic Strep: diagnosis
- Rapid strep antigen test (swab)
if swab is negative do culture
- Throat culture (“gold standard”)
Group A Beta Hemolytic Strep: treatment
Penicilllin VK BID for 10 days
[tastes baddd]
Amoxicillin BID for 10 days
If PCN allergy –>cephalexin
Acute Rheumatic fever (post strep): signs and symptoms
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:
- Arthralgia
- Fever
- ESR elevated
- Prolonged PR interval
How many major and minor criteria are needed from the Jones criteria to dx Acute rheumatic fever?
2 major
or
1 major + 2 minor
Group A beta hemolytic strep: dx
ASO titers
Group A beta hemolytic strep: tx
Amoxicillin
ASA
Evaluate for CHF, cardiomegaly
Post streptococcal Glomerulonephritis: S/Sx
- Edema
- Hematuria (tea-colored urine)
- Proteinuria
- HTN
Peritonsillar abscess
- S. pyogenes
- older kids and adolescents
- difficulty/pain with swallowing
- muffled “hot potato” voice**
Peritonsillar abcess: diagnosis
- deviated uvula
- CT with contrast
- Aspiration
Peritonsillar abscess: Tx
AIRWAY
-incision and drainage
Coxsackie virus
“hand, foot and mouth disease”
S/Sx:
- oral lesions “herpangina” on tongue
- rash on hands and feet
- Usually under 5 years
Coxsackie virus: signs and symptoms
- Refusal to eat or drink, drooling
- sore throat
- headache
- low grade fever
Coxsackie virus: tx
supportive
Herpetic Gingivostomatitis
- HSV-1 infection
- ulcerative lesions of the gingiva and mucous membranes
Herpetic gingivostomatitis: signs and symptoms
- ulcerated lesions bleed if disturbed**
- 3-4 day prodrome
Herpetic gingivostomatitis: tx
- oral acyclovir (if had for fewer than 4 days
- NSAIDs/acetaminophen
- Hydration
Measles: Prodrome symptoms
- Koplik spots** (whitish elevations on an erythematous base opposite the molars (2 days before rash)
- conjunctivitis, coryza and cough
Measles: rash
-Maculopapular, blanching rash begins on face spreads to neck, trunk, extremitis
Measles: Dx
IgM assay
Mumps: S/sx
Unilateral, swelling and tenderness of the parotid gland
- Orchitis (fever, testicular pain, swelling)
- Oophoritis (females)
Mumps: TX
supportive
Rubella: signs and symptoms
fever with post auricular and occipital adenopathy
-Rash starts on face spreads over 24 hours, disappears within 3 days
Congenital Rubella syndrome
- hearing loss, mental retardation, CV defects, ocular defects
- Purpuric “blueberry muffin” rash at birth
- jaundice, thrombocytopenia, deafness
Candidiasis (diaper)
“beefy red” with satellite lesions
- candida albicans
- involves skin folds
Candidiasis: tx
AVOID steroids!
-topical clotrimazole
Cradle cap
- seborrheic dermatitis
- greasy, yellowish scales on scalp
Cradle cap: tx
- Apply emollient (ex. petroleum jelly)
2. Use soft baby-brush
Impetigo
- staph aureus
- “honey colored crusts”on face or extremities
Impetigo: tx
mupirocin topical antibiotic for 3-5 days
