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Pediatrics Exam 2 > HEENT > Flashcards

HEENT Flashcards

1
Q

Bacterial conjunctivitis etiology

A

strep pneumo, H influenza, Moraxella cat

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2
Q

Clinical presentation of bacterial conjunctivitis

A

unilateral injection, thick purulent discharge, eye “stuck shut”

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3
Q

Tx for bacterial conjunctivitis

A

EES ointment, trimethoprim-polymyxin B drops

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4
Q

Neonatal conjunctivitis

A

presents 5-14 days of life; watery to mucopurulent to bloody d/c, chemosis, pseudomembrane

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5
Q

Neonatal conjunctivitis etiology

A

Chlamydia trachomatis

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6
Q

Dx for neonatal conjunctivitis

A

CULTURE

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7
Q

Tx for neonatal conjunctivitis

A

Oral erythromycin (50 mg/kg per day in 4 doses x 14 days)

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8
Q

Hyperacute bacterial conjunctivitis etiology

A

N. gonorrhoeae

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9
Q

Hyperacute bacterial conjunctivitis

A

severe & sightpthreatening; keratitis and perforation can occur; 2-5 days after birth, profuse, purulent discharge, chemosis, urethritis

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10
Q

Tx for hyperacute bacterial conjunctivitis

A

REFER TO OPTHAMOLOGY, HOSPITILIZE

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11
Q

Contact lens wear

A

high risk of pseudomonal keratitis, can lead to ulcerative keratitis (perforation)

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12
Q

Keratitis features

A

foreign body snesation, blepharospasm, typically visible corneal opacity with penligh

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13
Q

Tx for keratitis

A

URGENT REFERRAL; discontinue contacts, abx (anti-psuedomonal)

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14
Q

Viral conjunctivitis etiology

A

Adenovirus

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15
Q

Viral conjunctivitis presentation

A

+/- prodrome; injection (burning, gritty sensation), watery d/c

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16
Q

Tx for viral conjunctivitis

A

self-limited; warm or cool compresses, topical antihistamines/decongestants (Naphcon-A), lubricant eye drops

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17
Q

Education for infectious conjunctivitis

A

stay home from school until there is no longer any discharge (@ least 24 hrs topical therapy); sports: non-contact when they feel okay, contact: once daytime d/c has stopped (usually 5 days)

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18
Q

Allergic conjunctivitis

A

bilateral injection, edema, d/c (stringy), ocular pruritus

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19
Q

Tx for allergic conjunctivitis

A

symptomatic (cool compress, avoid allergens, lubricants), pharm:
topical vasoconstrictor + antihistamine (<2 weeks) (Naphcon-A, Visine-A), ANTIHISTAMINE W/ MAST-CELL STABILIZING (olopatadine, azelastine), mast-cell stabilizer (cromolyn), NSAIDs, glucocorticoids by opthamology (don’t prescribe)

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20
Q

Kawasaki disease

A

mucocutaneous lymph node syndrom; small and medium vessel vasculitis

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21
Q

Kawasaki disease Sx.

A

(crash)
Conjunctivitis (bilateral, nonexudative)
Rash (morbilliform)
Adenopathy (cervical)
Strawberry tongue (cracked, red lips, fissuring)
Hands (red, swollen w/ subsequent desquamation)

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22
Q

Unexplained fever longer than 5 days

A

Consider KD

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23
Q

Dx for KD

A

fever >5 days plus 4/5:

  1. Bilateral conjunctivitis
  2. Oral mucous membrane changes, fissured lips, strawberry tongue
  3. peripheral extremity changes (erythema, edema, desquamation)
  4. Polymorphous rash
  5. Cervical LAD
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24
Q

KD complications

A 
cardiovascular complications (coronary aneurysms, carditis); manifestations: tachycardia, gallop, muffled heart tones
Young infants: fusiform aneurysms of brachial arteries: palpable/visible in axillae; cold pale, cyanotic digits
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25
Q

Dx for KD

A

ECHOCARDIOGRAM

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26
Q

Tx for KD

A

ID and CV consults (long-term cardio f/u); Intravenous immunoglobin (IVIG)- provides extra antibodies, reduces prevalence of carotid artery aneurysms; high dose aspirin, delay vaccines

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27
Q

Strabismus

A

misalignment of eyes; potential to cause amblyopia (decreased acuity)

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28
Q

Dx of strabismus

A

abnormal corneal light reflection, cover/uncover test

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29
Q

Tx of stabismus

A

refer to opthamology

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30
Q

Dacryostenosis

A

nasolacrimal duct obstruction

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31
Q

Most common cause of tearing & ocular d/c in infants/young children

A

Dacryostenosis

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32
Q

Etiology of dacryostenosis

A

congenital

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33
Q

Presentation of dacrystenosis

A

chronic, intermittent tearing; mucoid d/c, debris on lashes, mild redness of lower lid from rubbing

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34
Q

Tx for dacryostenosis

A

most resolve spontaneously by 6 mo; lacrimal sac massage (1st line); refer to opthamology for sx >6-7 mo, complications; Surgical management for definitive treatment (surgical probe)

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35
Q

Dacryocystitis

A

inflammation or infection of lacrimal sac; rare complication of dacryostenosis

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36
Q

complication of dacryostenosis

A

dacryocystitis

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37
Q

Etiology of dacryocystitis

A

Staph epidermis and staph aureus

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38
Q

Clinical presentation of dacryocystitis

A

erythema, swelling, warmth, tenderness of lacrimal sac, purulent d/c

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39
Q

Tx of dacryocystitis

A

C&S, treat promptly with empiric abx (x7-10 days) (Clindamycin PO (mild), IV vanco (severe) + 3rd generation cephalosporin), Opthamology referral

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40
Q

AOM etiology

A

strep pneumonia, haemophilus influenza, moraxella catarrhalis

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41
Q

Risk factors for AOM

A

peak @ 6-18 mo, then 5-6 yo; family hx, day care, lack of breastfeeding, tobacco smoke or air polluiton, pacifier use

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42
Q

AOM Sx.

A

otalgia, irritability, fever, anorexia, vomiting, diarrhea

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43
Q

AOM PE findings

A

bulging, erythematous TM; TM with decreased mobility, otorrhea, hearing loss

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44
Q

Complications of AOM

A

perforation, hearing loss, cholesteatoma, facial nerve palcy, mastoiditis

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45
Q

Dx for AOM

A

bulging TM (or other signs of inflammation) AND middle ear effusion (decreased Tm mobility, otorrhea)

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46
Q

Tx for AOM

A

amoxicillin (90mg/kg/day divided by 12 hrs) (<2 yo = 10 days, >2 yo = 5-7 days)

47
Q

AOM tx <2

A

amoxicillin x 10 days

48
Q

AOM tx >2

A

amoxicillin x 5-7 days

49
Q

Tx for AOM when resistance suspected

A

Amoxicillin-Clavulanate (Augmentin)

50
Q

Resistance risk for AOM

A

recent beta-lactam, purulent conjunctivitis and recurrent AOM

51
Q

AOM tx for PCN allergy

A

cefdinir (2nd line if not Type I allergic response) or azithromycin (3rd line), clindamycin, TMP-SMX

52
Q

Tx for AOM

A

abx + follow up 48-72 hours

53
Q

When are Abx given for AOM

A
  • all children < 6 mo
  • all children w/ severe sx (moderate/severe ear pain, ear pain >48 hrs, temp >102)
  • bilateral AOM <2 yrs
  • unilateral AOM <2 yrs
54
Q

Recurrent AOM

A

> 3 episodes in 6 months; >4 episodes per year

55
Q

Tx for recurrent AOM

A

daily abx (amoxicillin 40mg/kd or sulfisoxazole 50 mg/kg); myringotomy and tympanostomy tubes if prophylactic abx doesn’t work

56
Q

OME

A

amber, gray or blue, cloudy, opague, RETRACTED TM; decreased mobility of TM, hearing loss

57
Q

OME tx

A

symptomatic; eval and heart test q 3-6 months (until resolved or tubes

58
Q

Otitis externa etiology

A

P. aeruginosa, s. aureus, s. epidermis

59
Q

OE Sx.

A

otalgia, pruritus, d/c

60
Q

OE PE findings

A

hearing loss, tragus tenderness, erythema and/or edema of ear canal

61
Q

OE Tx

A

Floxin Otic solution (ofloxacin)
cortisporin otic suspension (not with perforated TM)
ciprodex

62
Q

Allergic rhinitis patterns

A

intermittent: Sx <4 day/week or <4 weeks
Persistent: Sx >4days/week AND >4 weeks

63
Q

Sx of allergic rhinitis

A

shiners, dennie-morgan lines, tears, allergic salute, pale/bluish boddy nasal mucosa, edematous turbinates; cobblestoning in pharynx

64
Q

Dx for allergic rhinitis

A

clinica; IgE levels, skin testing, serum testing; imaging for chronic

65
Q

Tx for allergic rhinitis

A

allergen avoidance, pharmacotherapy, allergen immunotherapy

66
Q

Pharm tx for allergic rhinitis

A

intranasal steroids (Flonase), antihistamines, decongestants (pseudophedrine), anticholinergics (ipratropium), Mast cell stabilizer (cromolyn), LTR antagonist (montelukast)

67
Q

Immunotherapy for allergic rhinitis

A

patient has maximized environmental control measure and optimal medication regimen; subq injections 1-2/week

68
Q

Nasal polyps

A

benign pedunculated tumors, “pealed grape” appearance; formed from chronically inflamed nasal mucosa

69
Q

Nasal polyps are associated with

A

CF (child <12 w/ polyps), chronic sinusitis, allergic rhinits

70
Q

SAMTER’s TRIAD

A

nasal polyps, ASA sensitivity & asthma

71
Q

Nasal polyps PE findings

A

obstruction of nasal passages (hyponasal speech and mouth breathing), inflamed nasal mucosa, profuse unilateral mucoid/mucopurluent rhinorrhea

72
Q

Tx for nasal polyps

A

decongestants, intranasal steroid, systemic steroids, surgical removal

73
Q

Viral URI

A

“common cold”

74
Q

Duration of viral URI

A

14 days

75
Q

Etiology of viral URI

A

rhinovirus

76
Q

Complications of viral URI

A

AOM, asthma exacerbation, acute bacterial sinustitis, lower respiratory tract disease (PNA)

77
Q

Viral URI tx

A

avoid OTC without direction, Do not use <6 YO, avoid in 6-12 YO; use antitussive, expectorant

78
Q

acute rhinosinusitis

A

preceding viral URI

79
Q

Etiology of rhinosinusitis

A

viral infection; s. pneumoniae, h.influenzae, m. catarrhalis

80
Q

Acute bacterial rhinosinusitis

A

nasal sx, cough worse at night, fever, HA, facial pain; mild erythema of turbinates, mucopurulent d/c, postnasal drainage in pharynx

81
Q

Bacterial rhinosinusitis

A

sx >10 dyas, <30 days, not improving; severe sx or double sickening

82
Q

Chronic rhinosinusitis

A

> 12 weeks and 2 of the following: d/c, nasal obstruction, facial pain, decreased sense of smell

83
Q

Dx for acute rhinosinusitis

A

XR/CT

84
Q

Dx for chronic rhinosiusitis

A

XR, CT, MR, maybe culture

85
Q

Tx for acute sinusitis

A

saline irrigation, decongestant, antihistamine; Abx if bacterial: Augmentin 45 mg/kg

86
Q

Med for bacterial sinusitisi

A

augmentin 45 mg/kg/day

87
Q

Etiology of pharyngitis

A

usually viral (adenovirus, coxsackie), bacterial (GAS)

88
Q

Sx of pharyngitis

A

sore throat, fever; tonsillopharyngeal erythema, enlarged tonsils, LAD

89
Q

Tx for viral pharyngitis

A

supportive, miracle mouth wash

90
Q

Mono etiology

A

EBV

91
Q

Sx of mono

A

fevere, sore throat, FATIGUE, malaise, LAD, SPLENOMEGALY

92
Q

Dx of mono

A

CBC w/ differential, HETEROPHILE ANTIBODY TEST (monospot), strep test (RADT, culture)

93
Q

Tx for mono

A

may persist 7-21 days; supportive; activity restriction for 4 weeks

94
Q

Bacterial pharyngitis etiology

A

GAS; peak incidence winter/early spring (5-15 YO)

95
Q

Grading system for strep

A 
Age: 5-15 YO
Season: late fall, winter, early spring
pharyngitis (erythema, edema, exudates)
LAD
Fever (101-103)
Absence of cough

Scoring: 6 = likelihood 85%
scoring: 5: likelihood falls to 50%

96
Q

GAS Sx

A

abrupt onset, sore throat, odynophagia; exudate, palatal petechiae, tender LAD, scarlet fever

97
Q

Centor criteria

A

Tonsillar exudates
tender LAD
fever by hx
Absence of cough

0-2 score: unlikely GAS
>3 score: reform RADT

98
Q

If clinical suspicion is high with negative RADT for strep what do you do next

A

Throat culture

99
Q

Dx of strep

A

RADT; throat culture if RADT is negative

100
Q

Tx for strep

A

abx in first 48 hours (penicillin, amoxicillin; 1st gen cephalosporin); Azithromycin for PCN allergy

101
Q

GAS complications

A

Acute rheumatic fever (ARF)- 2-4 weeks after infection;

Post-streptococal glumerulonephritis (PSGN)

102
Q

5 manifestations of Acute Rheumatic fever

A 
migratory arthritis
carditis (valve damage)
CNS involvement
Subcutaneous nodules (firm, painless)
erythema marginatum (pink/non-pruritic rash to trunk and limbs, not face)
103
Q

post-streptococcal glomerulonephritis (PSGN) sx

A

asymptomatic, microscopic hematuria; full blown = brown urine;
Common sx: generalized edema, gross hematuria, hypertension

104
Q

Dx of PSGN

A

Urinalysis: hematuria
complement
positive streptozyme test

105
Q

Tx for PSGN

A

supportive; treat volume overload (sodium and water restriction, diuretics), dialysis if renal failure

106
Q

Tonsillectomy indications

A

Paradise criteria:

7 episodes in last year OR 5 episodes in each of the past 2 years OR 3 episodes in each of the past 3 years

107
Q

Thrush

A

occurs often after abx; caused by candida albicans; adherent white plaque that brushes off

108
Q

Tx for thrush

A

nystatin oral suspension

109
Q

Mumps

A

late winter/early spring; incubation 16-18 days; infectious 3 days prior and 9 days after sx

110
Q

Sx of mumps

A

within 48 hrs parotitis develops (fever, HA, myalgia, etc)

111
Q

Complications of mumps

A

orchitis or oophoritis, neuro (meningitis, encepahlitis, deafness), arthritis, pancreatitis, etc.

112
Q

Parotitis

A

cause: Mumps; bacterial (purulent d/c from stenson;s), noninfectious; ages 2-9

113
Q

Sx of partotitis

A

salivary gland swelling for up to 10 days; orifice of stensen’s duct is erythematous and enlarged

114
Q

Tx for Mumps/partotitis

A

supportive (acetaminophen, cold/warm packs)

Pediatrics Exam 2 (3 decks)

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