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Peds I & II > HEENT > Flashcards

HEENT Flashcards

1
Q

Bacterial conjunctivitis #1 etiology in NEWBORNS

A

Chlamydia trachomatis

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2
Q

Bacterial conjunctivitis si/sx

A
  1. Thick, Purulent, Ropy discharge: “crusted shut”

2. Unilateral

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3
Q

Bacterial conjunctivitis treatment

A

Infants=Abx ointment
Children=Abx drops

*Tx both eyes

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4
Q

Viral conjunctivitis etiology

A

Adenovirus

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5
Q

Viral conjunctivitis si/sx’s

A
  1. Bilateral
  2. Injected conjunctiva
  3. “Gritty sensation”, watery
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6
Q

Allergic conjunctivitis si/sx

A
  1. Bilateral
  2. PRURITIC!
  3. water, red eyes
  4. Allergic rhinitis sx’s: coughing, sneezing, atopic dermatitis
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7
Q

Allergic conjunctivitis treatment

A

Children > 2 years= Olopatadine

Reduce exposure

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8
Q

Define Preseptal/Periorbital cellulitis

A

infxn ANTERIOR to orbital septum

D/t exogenous source: eyelid abrasion, chalazion, insect bite

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9
Q

What are the two MC pathogen in Periorbital cellulitis

A

S. aureus

S. progenies

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10
Q

Periorbital cellulitis si/sx’s

A
  1. Eyelid swelling, redness, pain
  2. Mild fever
  3. Vision & EOMS are NORMAL
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11
Q

Define Orbital cellulitis

A

infxn POSTERIOR to orbital septum

Children>Adults

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12
Q

What is Orbital cellulitis commonly associated with/complication of?

A

Bacterial Rhinosinusitis

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13
Q

Orbital cellulitis si/sx

A
  1. Eyelid swelling, redness, pain
  2. Fever (high grade)
  3. PAIN with EOMS, proptosis
  4. Decreased vision
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14
Q

Orbital cellulitis treatment

A

Emergent Ophthalmology consult
IV abx: Ceftriaxone, Vancomycin, Unasyn, Clindamycin
+/- surgical drainage

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15
Q

What is the leading cause of acquired heart disease in children in the US?

A

Kawasaki Disease

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16
Q

Define Kawasaki Disease

A

Widespread inflammation of medium and small arteries (including coronary arteries)

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17
Q

Who is Kawasaki Disease MC in?

A

Boys>Girls
Asian Ancestry
Children <5

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18
Q

Kawasaki Disease clinical presentation

A

CRASH & BURN (Fever >5 days)

  1. Conjunctivitis (B/L)
  2. Rash: Starts on perineum, skin peels, spreads
  3. Adenopathy: Cervical
  4. Strawberry Tongue
  5. Hands & Feet involvement: edema, redness
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19
Q

Kawasaki Disease treatment

A

IVIG (Intravenous immune globulin) + ASA

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20
Q

What must you NOT administer within 11 months of IVIG treatment?

A

Live Vaccines

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21
Q

Complications of Kawasaki Disease

A

CV:

  1. Coronary artery aneurysms: Myocardial ischemia/infarction
  2. Myocarditis
  3. Arrhythmias
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22
Q

How do you diagnose a Corneal Abrasion?

A

Apply Fluorescein stain & eval w/ Wood’s Lamp

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23
Q

When do you refer to ophthalmology for a corneal abrasion?

A
  1. Foreign body on exam

2. No decrease in size post abx ointment treatment for 24-48 hrs

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24
Q

What is the MC cause of persistent tearing & eye discharge in infants & children?

A

Dacryostenosis

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25
Q

Define DacryOstenosis

A

Nasolacrimal duct Obstruction

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26
Q

Dacryostenosis si/sx’s

A
  1. Tearing: Chronic or Intermittent
  2. NO conjunctival irritation
  3. Palpable nasolacrimal sac
  4. +/- discharge
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27
Q

Dacryostenosis treatment

A
  1. Lacrimal sac massage

2. Observation

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28
Q

When do you refer to ophthalmology for Dacryostenosis?

A

Sx’s persist > 6 months

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29
Q

Dacryocystitis etiology

A

2ry infxn of Dacryostenosis
Upper respiratory tract bacteria:
S. aureus, S. pneumoniae, S. progenes, S. viridian’s, M. catarrhalis, Haemophilus

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30
Q

Dacryocystitis si/sx

A

Swelling & erythema over nasolacrimal sac

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31
Q

SEVERE Dacryocystitis treatment

A

Culture

IV abx

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32
Q

Otitis Media 1st line treatment

A

Amoxicillin 80-90 mg/kg per day x10 days

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33
Q

Who always receives abx treatment in OM?

A

Up to 2 years

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34
Q

When would you treat OM with abx If > 2

A
  1. Appear toxic
  2. Ear pain >48 hrs
  3. Fever >102.2
  4. B/L OM or discharge
  5. Uncertain access to F/U
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35
Q

Treatment of OM w/ PE tubes w/ drainage

A

Fluoroquinolone abx drops
+/- corticosteroids
= Ciprofloxacin + dexamethasone (Ciprodex)

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36
Q

Define Serous Otitis Media

A

Middle ear effusion WITHOUT INFXN

37
Q

Serous Otitis Media si/sx’s

A
  1. Pain
  2. Pressure, “popping”
  3. Decreased hearing
  4. Disequilibrium
38
Q

Serous Otitis Media physical exam findings

A
  1. Bubbles/fluid
  2. TM grey, shiny
  3. TM immobile
  4. TM normal or retracted
39
Q

Otitis Externa physical exam findings

A
  1. Significant ear pain (tragal), unilateral

2. Malodorous discharge/exudate

40
Q

Otitis Externa treatment

A

Abx drops: Polymyxin B, Neomycin

41
Q

Otitis Externa with TM perforation treatment

A

Fluoroquinolone suspension

42
Q

Otitis Externa prevention

A
  1. Swim-Ear OTC

2. 50/50 rubbing alcohol & white vinegar after swimming

43
Q

Allergic Rhinitis physical exam findings

A
  1. Allergic Shiners
  2. Allergic Salute: Nasal crease
  3. Dennie Lines: d/t puffiness beneath eyes
  4. “Cobblestone”: posterior pharynx
  5. Pale, blueish/boggy nasal mucosa
  6. Clear Rhinorrhea
44
Q

Allergic Rhinitis treatment

A
  1. Intranasal Steroid Sprays: Nasacort AQ (>2), Flonase OTC (>4)
  2. Antihistamines:
    Oral-Diphenhydramine (1st gen), Cetirizine (2nd gen)
    Intranasal-Olopatadine
45
Q

BACTERIAL sinusitis si/sx’s

A

> 10-14 days of sx’s without improvement

  1. Fever (102.2)
  2. HA
  3. Purulent nasal discharge
  4. Sinus pain
46
Q

What is the MC bacterial pathogen in bacterial sinusitis?

A

S. pneumo

47
Q

1st line treatment in bacterial sinusitis

A
  1. Amoxicillin-Clavulanate 45 mg/kd/d BID (covers H. flu)

2. Amoxicillin 90 mg/kg/d

48
Q

Symptomatic treatment for mild/questionabile sx’s in sinusitis (likely viral)

A
  1. Intranasal saline irrigation
  2. Analgesics
  3. Humidifier/vaporizer
49
Q

Infectious Mononucleosis etiology

A

EBV

50
Q

EBV incubation period

A

4-8 weeks

51
Q

Infectious Mononucleosis (EBV) si/sx’s

A
  1. Exudative Tonsillitis
  2. Cervical Lymphadenopathy
  3. Splenomegaly
52
Q

Infectious Mononucleosis (EBV) labs/diagnostics

A
  1. Fingerstick: Monospot

2. EBV titers

53
Q

Infectious Mononucleosis (EBV) treatment

A
  1. Spleen precautions x6-8 weeks*
  2. Analgesics
  3. Fluids
  4. +/- steroids
54
Q

GABHS si/sx’s in children >3 y.o.

A
  1. Rash
  2. HA
  3. Nausea, abd pain
  4. Absent cough
55
Q

GABHS si/sx’s in children <3 y.o.

A

Atypical sx’s:

  1. Anterior cervical LAD
  2. Nasal congestion
  3. Low grade fever
56
Q

GABHS physical exam findings

A
  1. Palatal Petechiae*
  2. Enlarged/Tender Anterior Cervical LAD
  3. Exudative tonsillitis
57
Q

What is the INITIAL test you will order in GABHS?

A

Rapid Strep Antigen Test

58
Q

If rapid strep antigen test is negative, what should you perform?

A

Throat Culture=Gold standard

59
Q

What is Gold Standard Abx tx in GABHS

A

Penicillin VK: BID x 10 days

60
Q

Abx treatment if the patient has a NON-anaphylactoid PCN allergy

A

1st gen. cephalosporin: Cephalexin

61
Q

Abx treatment if the patient has anaphylactoid PCN allergy

A

Clindamycin TID x 10 days

62
Q

Major/Minor Criteria that indicates high likelihood of Acute Rheumatic Fever

A

2 Major Jones Criteria OR

1 Major + 2 Minor

63
Q

What is the #1 cause of acquired valve dz WORLDWIDE?

A

Rheumatic heart disease

64
Q

Rheumatic Fever Diagnosis

A

+ ASO titers

65
Q

Rheumatic Fever Treatment

A
  1. Amoxicillin (tx strep pharyngitis)
  2. ASA
  3. Eval for carditis: Cardiomegaly, CHG, 3rd degree AV block
66
Q

Post-Streptococcal Glomerulonephritis (PGN) sis/x

A
  1. Edema
  2. Hematuria: Tea colored urine
  3. HTN
  4. Proteinuria
67
Q

PGN diagnosis

A

ASO titers

68
Q

What is the MC bacterial pathogen in a Peritonsillar Abscess

A

S. pyogenes (progression of bacterial tonsillitis)

69
Q

Peritonsillar Abscess si/sx’s

A
  1. Drooling
  2. Muffled/”Hot potato” voice
  3. Dysphagia
70
Q

Hand, Foot & Mouth Disease etiology

A

Cocksackie virus

71
Q

Herpetic Gingivostomatitis etiology. What is it?

A

HSV-1

Ulcerative lesions of gingiva and mucous membranes

72
Q

Herpetic Gingivostomatitis si/sx’s

A
  1. 3-4 day “prodrome”

2. Ulcerated lesions that bleed if disturbed

73
Q

Herpetic Gingivostomatitis treatment

A
  1. Oral Acyclovir: if sx <4 days
  2. NSAID
  3. HYDRATION
74
Q

Measles (Rubeola) prodrome sx’s

A
  1. Conjunctivitis
  2. Coryza
  3. Cough
  4. Koplik Spots: 48 hr BEFORE rash
75
Q

Measles (Rubeola) physical exam findings

A

Exanthem rash: Maculopapular, blanching rash starting from HEAD to TOE

76
Q

Measles diagnosis

A

IgM assay

77
Q

Mumps incubation period

A

14-18 days

78
Q

Complications of mumps

A
  1. Orchitis=38% of post-pubertal males
  2. Oophoritis
  3. Sensorineural hearing loss
79
Q

Congenital Rubella (German measles) Syndrome si/sx

A

Purpuric “blueberry muffin” rash @ birth

80
Q

Congenital Rubella Syndrome complications

A
  1. Hearing loss
  2. Mental retardation
  3. CV & ocular defects
  4. Deafness
  5. Jaundice, thrombocytopenia
81
Q

Rubella prevention

A

VACCINATE

82
Q

Diaper Candidiasis appearance

A

Beefy red erythema with satellite lesions

Involves skin folds

83
Q

Diaper Candidiasis treatment

A

Topical Antifungal: Clotrimazole

84
Q

Cradle Cap (seborrheic dermatitis) appearance

A

Greasy, yellow scales: Scalp, ear, face

85
Q

What is Cradle Cap (seborrheic dermatitis) associated with?

A

Malessezia furfur

86
Q

Cradle Cap (seborrheic dermatitis) treatment

A

Apply emollient + soft baby brush to gently remove from scalp

87
Q

Mild Impetigo treatment

A

Topical Abx: Mupirocin (Bactroban)

88
Q

Severe Impetigo treatment

A

Mupirocin ointment + PO Keflex

Peds I & II (8 decks)

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