HEENT Flashcards
Bacterial conjunctivitis #1 etiology in NEWBORNS
Chlamydia trachomatis
Bacterial conjunctivitis si/sx
- Thick, Purulent, Ropy discharge: “crusted shut”
2. Unilateral
Bacterial conjunctivitis treatment
Infants=Abx ointment
Children=Abx drops
*Tx both eyes
Viral conjunctivitis etiology
Adenovirus
Viral conjunctivitis si/sx’s
- Bilateral
- Injected conjunctiva
- “Gritty sensation”, watery
Allergic conjunctivitis si/sx
- Bilateral
- PRURITIC!
- water, red eyes
- Allergic rhinitis sx’s: coughing, sneezing, atopic dermatitis
Allergic conjunctivitis treatment
Children > 2 years= Olopatadine
Reduce exposure
Define Preseptal/Periorbital cellulitis
infxn ANTERIOR to orbital septum
D/t exogenous source: eyelid abrasion, chalazion, insect bite
What are the two MC pathogen in Periorbital cellulitis
S. aureus
S. progenies
Periorbital cellulitis si/sx’s
- Eyelid swelling, redness, pain
- Mild fever
- Vision & EOMS are NORMAL
Define Orbital cellulitis
infxn POSTERIOR to orbital septum
Children>Adults
What is Orbital cellulitis commonly associated with/complication of?
Bacterial Rhinosinusitis
Orbital cellulitis si/sx
- Eyelid swelling, redness, pain
- Fever (high grade)
- PAIN with EOMS, proptosis
- Decreased vision
Orbital cellulitis treatment
Emergent Ophthalmology consult
IV abx: Ceftriaxone, Vancomycin, Unasyn, Clindamycin
+/- surgical drainage
What is the leading cause of acquired heart disease in children in the US?
Kawasaki Disease
Define Kawasaki Disease
Widespread inflammation of medium and small arteries (including coronary arteries)
Who is Kawasaki Disease MC in?
Boys>Girls
Asian Ancestry
Children <5
Kawasaki Disease clinical presentation
CRASH & BURN (Fever >5 days)
- Conjunctivitis (B/L)
- Rash: Starts on perineum, skin peels, spreads
- Adenopathy: Cervical
- Strawberry Tongue
- Hands & Feet involvement: edema, redness
Kawasaki Disease treatment
IVIG (Intravenous immune globulin) + ASA
What must you NOT administer within 11 months of IVIG treatment?
Live Vaccines
Complications of Kawasaki Disease
CV:
- Coronary artery aneurysms: Myocardial ischemia/infarction
- Myocarditis
- Arrhythmias
How do you diagnose a Corneal Abrasion?
Apply Fluorescein stain & eval w/ Wood’s Lamp
When do you refer to ophthalmology for a corneal abrasion?
- Foreign body on exam
2. No decrease in size post abx ointment treatment for 24-48 hrs
What is the MC cause of persistent tearing & eye discharge in infants & children?
Dacryostenosis
Define DacryOstenosis
Nasolacrimal duct Obstruction
Dacryostenosis si/sx’s
- Tearing: Chronic or Intermittent
- NO conjunctival irritation
- Palpable nasolacrimal sac
- +/- discharge
Dacryostenosis treatment
- Lacrimal sac massage
2. Observation
When do you refer to ophthalmology for Dacryostenosis?
Sx’s persist > 6 months
Dacryocystitis etiology
2ry infxn of Dacryostenosis
Upper respiratory tract bacteria:
S. aureus, S. pneumoniae, S. progenes, S. viridian’s, M. catarrhalis, Haemophilus
Dacryocystitis si/sx
Swelling & erythema over nasolacrimal sac
SEVERE Dacryocystitis treatment
Culture
IV abx
Otitis Media 1st line treatment
Amoxicillin 80-90 mg/kg per day x10 days
Who always receives abx treatment in OM?
Up to 2 years
When would you treat OM with abx If > 2
- Appear toxic
- Ear pain >48 hrs
- Fever >102.2
- B/L OM or discharge
- Uncertain access to F/U
Treatment of OM w/ PE tubes w/ drainage
Fluoroquinolone abx drops
+/- corticosteroids
= Ciprofloxacin + dexamethasone (Ciprodex)
Define Serous Otitis Media
Middle ear effusion WITHOUT INFXN
Serous Otitis Media si/sx’s
- Pain
- Pressure, “popping”
- Decreased hearing
- Disequilibrium
Serous Otitis Media physical exam findings
- Bubbles/fluid
- TM grey, shiny
- TM immobile
- TM normal or retracted
Otitis Externa physical exam findings
- Significant ear pain (tragal), unilateral
2. Malodorous discharge/exudate
Otitis Externa treatment
Abx drops: Polymyxin B, Neomycin
Otitis Externa with TM perforation treatment
Fluoroquinolone suspension
Otitis Externa prevention
- Swim-Ear OTC
2. 50/50 rubbing alcohol & white vinegar after swimming
Allergic Rhinitis physical exam findings
- Allergic Shiners
- Allergic Salute: Nasal crease
- Dennie Lines: d/t puffiness beneath eyes
- “Cobblestone”: posterior pharynx
- Pale, blueish/boggy nasal mucosa
- Clear Rhinorrhea
Allergic Rhinitis treatment
- Intranasal Steroid Sprays: Nasacort AQ (>2), Flonase OTC (>4)
- Antihistamines:
Oral-Diphenhydramine (1st gen), Cetirizine (2nd gen)
Intranasal-Olopatadine
BACTERIAL sinusitis si/sx’s
> 10-14 days of sx’s without improvement
- Fever (102.2)
- HA
- Purulent nasal discharge
- Sinus pain
What is the MC bacterial pathogen in bacterial sinusitis?
S. pneumo
1st line treatment in bacterial sinusitis
- Amoxicillin-Clavulanate 45 mg/kd/d BID (covers H. flu)
2. Amoxicillin 90 mg/kg/d
Symptomatic treatment for mild/questionabile sx’s in sinusitis (likely viral)
- Intranasal saline irrigation
- Analgesics
- Humidifier/vaporizer
Infectious Mononucleosis etiology
EBV
EBV incubation period
4-8 weeks
Infectious Mononucleosis (EBV) si/sx’s
- Exudative Tonsillitis
- Cervical Lymphadenopathy
- Splenomegaly
Infectious Mononucleosis (EBV) labs/diagnostics
- Fingerstick: Monospot
2. EBV titers
Infectious Mononucleosis (EBV) treatment
- Spleen precautions x6-8 weeks*
- Analgesics
- Fluids
- +/- steroids
GABHS si/sx’s in children >3 y.o.
- Rash
- HA
- Nausea, abd pain
- Absent cough
GABHS si/sx’s in children <3 y.o.
Atypical sx’s:
- Anterior cervical LAD
- Nasal congestion
- Low grade fever
GABHS physical exam findings
- Palatal Petechiae*
- Enlarged/Tender Anterior Cervical LAD
- Exudative tonsillitis
What is the INITIAL test you will order in GABHS?
Rapid Strep Antigen Test
If rapid strep antigen test is negative, what should you perform?
Throat Culture=Gold standard
What is Gold Standard Abx tx in GABHS
Penicillin VK: BID x 10 days
Abx treatment if the patient has a NON-anaphylactoid PCN allergy
1st gen. cephalosporin: Cephalexin
Abx treatment if the patient has anaphylactoid PCN allergy
Clindamycin TID x 10 days
Major/Minor Criteria that indicates high likelihood of Acute Rheumatic Fever
2 Major Jones Criteria OR
1 Major + 2 Minor
What is the #1 cause of acquired valve dz WORLDWIDE?
Rheumatic heart disease
Rheumatic Fever Diagnosis
+ ASO titers
Rheumatic Fever Treatment
- Amoxicillin (tx strep pharyngitis)
- ASA
- Eval for carditis: Cardiomegaly, CHG, 3rd degree AV block
Post-Streptococcal Glomerulonephritis (PGN) sis/x
- Edema
- Hematuria: Tea colored urine
- HTN
- Proteinuria
PGN diagnosis
ASO titers
What is the MC bacterial pathogen in a Peritonsillar Abscess
S. pyogenes (progression of bacterial tonsillitis)
Peritonsillar Abscess si/sx’s
- Drooling
- Muffled/”Hot potato” voice
- Dysphagia
Hand, Foot & Mouth Disease etiology
Cocksackie virus
Herpetic Gingivostomatitis etiology. What is it?
HSV-1
Ulcerative lesions of gingiva and mucous membranes
Herpetic Gingivostomatitis si/sx’s
- 3-4 day “prodrome”
2. Ulcerated lesions that bleed if disturbed
Herpetic Gingivostomatitis treatment
- Oral Acyclovir: if sx <4 days
- NSAID
- HYDRATION
Measles (Rubeola) prodrome sx’s
- Conjunctivitis
- Coryza
- Cough
- Koplik Spots: 48 hr BEFORE rash
Measles (Rubeola) physical exam findings
Exanthem rash: Maculopapular, blanching rash starting from HEAD to TOE
Measles diagnosis
IgM assay
Mumps incubation period
14-18 days
Complications of mumps
- Orchitis=38% of post-pubertal males
- Oophoritis
- Sensorineural hearing loss
Congenital Rubella (German measles) Syndrome si/sx
Purpuric “blueberry muffin” rash @ birth
Congenital Rubella Syndrome complications
- Hearing loss
- Mental retardation
- CV & ocular defects
- Deafness
- Jaundice, thrombocytopenia
Rubella prevention
VACCINATE
Diaper Candidiasis appearance
Beefy red erythema with satellite lesions
Involves skin folds
Diaper Candidiasis treatment
Topical Antifungal: Clotrimazole
Cradle Cap (seborrheic dermatitis) appearance
Greasy, yellow scales: Scalp, ear, face
What is Cradle Cap (seborrheic dermatitis) associated with?
Malessezia furfur
Cradle Cap (seborrheic dermatitis) treatment
Apply emollient + soft baby brush to gently remove from scalp
Mild Impetigo treatment
Topical Abx: Mupirocin (Bactroban)
Severe Impetigo treatment
Mupirocin ointment + PO Keflex