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X Pediatrics Exam 2 > HEENT > Flashcards

HEENT Flashcards

1
Q

What types of conjunctivitis are contagious?

A

Bacterial and viral

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2
Q

Etiology of bacterial conjunctivitis

A

Strep pneumo, H flu or M cat

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3
Q

Clinical presentation of bacterial conjunctivitis

A

Unilateral injection, thick purulent discharge

Report that eye is stuck shut

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4
Q

Tx of bacterial conjunctivitis

A

Erythromycin ophthalmic ointment

Trimethoprim-polymyxin B drops

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5
Q

When does neonatal conjunctivitis present?

A

5 and 14 days of life

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6
Q

Etiology of neonatal conjunctivitis

A

Chlamydia trachomatis

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7
Q

Clinical presentation of neonatal conjunctivitis

A

Watery to mucopurulent to bloody discharge
Chemosis
Pseudomembrane

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8
Q

Gold standard for diagnosis of neonatal conjunctivitis

A

Culture!!

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9
Q

Tx for neonatal conjunctivitis

A

Oral erythromycin (topical is not effective)

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10
Q

Presentation of hyperacute bacterial conjunctivitis due to Neisseria

A 
Severe and sight threatening (keratitis/perforation may occur)
2-5 days after birth
Rapidly progressive
Profuse, purulent discharge
Marked chemosis
Typically also see urethritis
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11
Q

What is a risk of contact lens wearers?

A

Pseudomonal keratitis (ulcerative)

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12
Q

Presentation of keratitis

A

Foreign body sensation
Blepharospasm (can’t hold eye open)
Usually have visible corneal opacity with penlight

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13
Q

Etiology of viral conjunctivitis

A

Adenovirus

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14
Q

Presentation of viral conjunctivitis

A

Injection, burning/gritty sensation in eye

Watery, scant stringy mucus

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15
Q

Tx of viral conjunctivitis

A

Self-limiting
Warm compresses
Topical antihistamines/decongestants (OTC Naphcon-A over 6 yo)
Lubricant eye drops/ointment OTC

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16
Q

How long should a child with infectious conjunctivitis stay home?

A

Until there is no longer any discharge (about 24 hours after start abx)

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17
Q

Presentation of allergic conjunctivitis

A

Bilateral injection, edema, discharge is water/scant/stringy
Itching
History of atopy of other allergies

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18
Q

Pharmacologic tx of allergic conjunctivitis

A

Topical vasoconstrictor plus antihistamine (less than 2 wks)
OTC: Naphcon-A, Visine-A (over 6)
Antihistamine with mast cell stabilizing properties (over 3) like olopatadine or azelastine HCl
Mast cell stabilizers (over 4)-cromolyn
Topical NSAIDs
Topical glucocorticoids by opthalmologist

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19
Q

What is Kawasaki disease?

A

Small and medium sized vessel vasculitis (mucocutaneous lymph node syndrome)

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20
Q

Clinical presentation of Kawasaki disease

A 
Fever (5+ days and not responsive to tylenol)
CRASH
Conjunctivits (bilateral, nonexudative)
Rash (morbilliform)
Adenopathy (cervical)
Strawberry tongue
Hands (red, swollen with desquamation)
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21
Q

When should Kawasaki disease be considered?

A

All kids with prolonged explained fever over 5 days

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22
Q

What risks do kids with Kawasaki disease have?

A 
Cardiovascular complications (coronary aneurysms or carditis)
*They all need an echocardiogram!
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23
Q

Treatment of Kawasaki disease

A

Infectious disease and cardiology consults
IV intravenous immunoglobulin (provide extra antibodies and reduces prevalence of carotid artery aneurysms)
High dose aspirin (Race syndrome risk)
Delay vaccines because low immune system

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24
Q

Presentation of strabismus

A

Misalignment of eyes with potential to cause amblyopia (reduction in visual acuity)

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25
Q

Dx of strabismus

A

Abnormal corneal light reflection or cover/uncover

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26
Q

What is dacryostenosis?

A

Nasolacrimal duct obstruction

Most common cause of persistent tearing and ocular discharge in infants/kids

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27
Q

Clinical presentation of dacryostenosis

A

Chronic, intermittent tearing
Mucoid discharge
Debris on lashes
Mild redness of lower eyelid (rubbing)

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28
Q

First line tx of dacryostenosis

A

Lacrimal sac massage

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29
Q

Other management of dacryostenosis

A

Most resolve spontaneously (after 12 months unlikely)
Refer if persist past 6-7 mos
Surgical probe is definitive management

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30
Q

What is dacryocystitis?

A

Inflammation or infection of lacrimal sac (rare complication of dacryostenosis)

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31
Q

Etiology of dacryocystitis

A

S. epidermidis or aureus

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32
Q

Clinical presentation of dacryocystitis

A

Erythema, swelling, warmth, tenderness of lacrimal sac, purulent discharge

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33
Q

Management of dacryocystitis

A

Obtain culture
Treat promptly with empiric abx (7-10 days) like oral clindamycin for mild or IV vanco plus 3rd gen cephalosporin (severe)
Refer to ophth

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34
Q

Etiology of AOM

A

Strep pneumonia, H influenza, moraxella catarrhalis

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35
Q

Symptoms of AOM

A

Otalgia, fever, irritability, anorexia, vomiting/diarrhea

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36
Q

Physical findings for AOM

A

Bulging TM, TM with decreased/absent mobility, distorted landmarks, erythematous TM, otorrhea, hearing loss

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37
Q

What do you need for diagnosis of AOM?

A

Bulging TM or other signs of acute inflammation (erythema of TM, otalgia, fever) AND middle ear effusion (opacity TM, decreased mobility, air fluid level, otorrhea)

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38
Q

Abx for AOM

A

High dose amoxicillin (90 mg/kg/day divided q 12 hours)
<2 yrs: 10 days
>2 yrs: 5-7 days
No recent beta lactam, no purulent conjunctivitis, no recurrent AOM

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39
Q

What abx use for AOM with penicillin allergy?

A

Cefdinir or azithromycin (clindamycin or TMP-SMX)

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40
Q

What is not recommended in kids to help treat AOM?

A

Decongestants or antihistamines because can cause convulsions

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41
Q

Guidelines for tx of AOM with abx

A

ALL children under 6 months
ALL children with severe signs/symptoms
Bilateral AOM < 2 yrs
<2 yrs with unilateral AOM (new on uptodate)

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42
Q

When do you want to follow up for AOM (within 28-72 hours)?

A

6 mos-2 years with unilateral non severe

OVer 2 with unilateral or bilateral non-severe

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43
Q

When you consider recurrent AOM prophylaxis

A

> 3 episodes in 6 months
4 episodes per yr if middle ear fluid is seen
Daily abx during winter months (Amoxicillin 40 mg or Sulfisoxazole 50 mg) 1 x day

44
Q

Clinical presentation of otitis media with effusion

A

No sxs of acute infection
Amber, gray, blue, cloudy opaque retracted TM
Decreased, absent mobility of TM
Hearing loss

45
Q

Management of otitis media with effusion

A

Tx symptoms

Clinical evaluation and hearing test every 3-6 mos until resolved or need surgery

46
Q

Main etiology of otitis externa

A

P. aeruginosa

47
Q

Symptoms of otitis externa

A

Otalgia, pruritus, discharge (tragus tenderness with erythema or edema of ear canal)

48
Q

Management of otitis externa

A

Aural toilet to clean canal
Treat inflammation and infection (topical)
Empiric (floxin otic, cortisporin suspension but not with perf!, ciprodex (with glucocorticoid))
Acidifying solutions
Ear wick PRN

49
Q

Risk factors for allergic rhinitis

A

Family history of atopy, male, first born, born in pollen season, early abx use, maternal smoking, indoor allergens

50
Q

2 patterns of symptoms for allergic rhinitis

A

Intermittent: sx < 4 days/wk or <4 wks
Persistent: sx > 4 days/wk and > 4 wks

51
Q

When is allergic rhinitis considered severe?

A 
One or more of the following:
Sleep disturbance
Impairment in school performance
Impairment of daily activities, leisures, sports
Troublesome symptoms
52
Q

Physical findings in allergic rhinitis

A

Allergic shiners, Allergic conjunctivitis sometimes, Denie-Morgan lines, tears, allergic salute, pale/bluish, boggy nasal mucosa, edematous turbinates, clear rhinorrhea, cobblestoning on posterior pharynx

53
Q

Management of allergic rhinitis

A

Allergen avoidance, pharmacotherapy, allergen immunotherapy

54
Q

First line tx for allergic rhinitis

A

Intranasal glucocorticoids (flonase)

55
Q

Other txs for allergic rhinitis

A

Antihistamines, decongestants, anticholinergics, mast cell stabilizers, LTR antagonists

56
Q

When do you consider immunotherapy?

A

When the pt has maximized environmental control measures and on the optimal medication regiment (usually wait til about 5 and usually about 3-5 yrs of maintenance therapy)

57
Q

Nasal polyps

A

Benign pedunculated tumors with pealed grape appearance (between nasal turbinates and septum)
Can be associated with cystic fibrosis (when kid is less than 12 this is suspected), chronic sinusitis, allerfig rhinits

58
Q

Samter’s triad

A

Nasal polyps, ASA sensitivity (NSAIDs), asthma

59
Q

Clinical findings of nasal polyps

A

Obstruction of nasal passages, inflamed mucosa, profuse unilateral mucoid/mucopurulent rhinorrhea

60
Q

Tx for nasal polyps

A

Decongestants, intranasal steroids, systemic steroids, surgical removal

61
Q

Most frequent human illness

A

Viral URI

62
Q

Physical findings of viral URI

A

Nontoxic appearing, may have low fever, erythema and edema of nasal mucosa, rhinorrhea (clear, yellow, green), abnormal middle ear pressure

63
Q

Viral URI in infants vs school-aged kids

A

Infants: fever, nasal discharge, fussiness

School aged: nasal congestion, discharge, cough

64
Q

Expected course of viral URI sxs

A

14 days (<6 have about 6-8 colds per year)

65
Q

Who should you never use OTC meds for?

A

Children <6 (suggest avoidance 6-12)

Kids 12-18 if obese or have conditions that may have serious breathing probs (apnea, lung disease)

66
Q

What is the downside to antitussives (codeine, dextromethorphan)?

A

Can delay or prevent coughing up mucus

Can cause drowsiness leading to death

67
Q

Symptoms of acute bacterial rhinosinusitis

A

Nasal (discharge, obstruction, congestion), cough might be worse at night, fever, HA, facial pain

68
Q

Classification of acute bacterial rhinosinusitis

A

Persistent symptoms >10 and <30 days
Severe sxs (high fever 102.2, purulent discharge for over 3 days, Ill appearing)
Double worsening

69
Q

Classification of chronic rhinosinusitis

A 
Over 12 weeks
2 or more of: 
Anterior/Posterior mucopurulent drainage
Nasal obstruction
Facial pain/pressure/fullness
Decreased sense of smell
70
Q

Management of acute sinusitis

A 
Saline nasal irrigation
Topical or oral decongestants 
Antihistamines
Intranasal glucocorticoids
If suspect bacterial then augmenting 45mg
71
Q

Management of chronic sinusitis

A 
Control predisposing factors
Nasal saline irrigation
Intranasal glucocorticoids
Maybe abx 
Anti leukotriene agents
Refer ent, otolaryngology etc
72
Q

Most common etiology of pharyngitis

A

Viral (adenovirus, coxsackie A)

73
Q

Sxs of viral pharyngitis

A

Sore throat and fever always

Rhinorrhea, nasal congestion, conjunctivitis, laryngitis, cough, wheezing, GI symptoms, exanthem

74
Q

Physical findings of viral pharyngitis

A

Tonsillopharyngeal erythema, enlarged tonsils, shotty LAD

75
Q

Management of viral pharyngitis

A 
Supportive care (Tylenol, ibuprofen etc) 
Symptomatic relief (miracle mouthwash, children younger than 6-8 usually can’t gargle correctly)
76
Q

Etiology of infectious mononucleosis

A

Epstein-barr virus

77
Q

Sxs of infectious mononucleosis

A

Fever, sore throat, fatigue, malaise

78
Q

Physical findings of infectious mononucleosis

A

Tender cervical LAD, palpable splenomegaly, resemble exudative GAS

79
Q

Diagnosis of infectious mononucleosis

A

CBC wth differential (lymphocytosis to see atypical lymphocytes)
Heterophile antibody test (monospot-rapid serologic test)
Strep test

80
Q

Management of infectious mononucleosis

A

May be 7-21 days
Supportive therapy
Activity restriction for 4 weeks (prevent splenic rupture)

81
Q

Etiology of bacterial pharyngitis

A

Group A streptococci (strep. pyogenes)

82
Q

Scoring of GAS pharyngitis to predict 85% change + throat culture

A

Age (15-30% cases in kids 5-15)
Season (late fall, winter, early spring)
Evidence of acute pharyngitis (erythema, edema, exudates)
Anterior cervical lymph nodes (tender, enlarged)
Fever (101-103)
Absence of usual URI sxs (like cough)
When only 5 of these, likelihood goes down to 50%

83
Q

Sxs of GAS pharyngitis

A

Abrupt onset, sore throat, odynophagia, maybe fever

84
Q

Physical findings of GAS pharyngitis

A

Pharyngeal erythema, exudate, uvular swelling, palatal petechiae, LAD, scarlet fever (scarlatinaform rash with diffuse sandpaper erythroderma or pastia’s lines)

85
Q

If suspicion is high with negative rapid antigen detecting (RADT) strep test, what’s next?

A

Throat culture!!!

86
Q

Centor criteria

A 
Tonsillar exudates
Tender anterior cervical LAD
Fever by history
Absence of cough
0-2: unlikely, over 3: perform RADT
87
Q

When must you start abx for GAS pharyngitis?

A

Within first 48 hours

88
Q

Abx for GAS pharyngitis

A

To prevent complications (carditis, acute rheumatic fever) and reduce spread
Oral penicillin, amoxicillin or 1st gen cephalosporin
Azithro for PCN allergy

89
Q

In what age and after when is acute rheumatic fever most common?

A

5-15 yo

2-4 wks after infection

90
Q

5 major manifestations of acute rheumatic fever

A

Migratory arthritis (inflammation affecting several joints)
Carditis (damage to cardiac valves may be chronic or progressive)
CNS involvement (up to 8 mos after-sydenham chorea which is abrupt non-rhythmic involuntary movements)
Subcutaneous nodules
Erythema marginatum (annulare)-pink/red, non-pruritic rash to trunk and limbs

91
Q

What history makes you worries for post-streptococcal glomerulonephritis (PSGN)?

A

GAS skin (3-6 wks prior) or other throat infection (1-3 wks prior)

92
Q

Clinical presentation of PSGN

A

Varies but most commonly edema, gross hematuria or hypertension

93
Q

Management of PSGN

A

Supportive
Treat volume overload (sodium and water restriction, loop diuretics-furosemide)
May need dialysis if kidney failure

94
Q

Paradise criteria for tonsillectomy

A

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

95
Q

What is considered an episode when considering a tonsillectomy?

A 
ST plus fever >100.9 OR
Tonsillar exudate OR
Cervical adenopathy OR
Culture confirmed GABHS
Recommend observing for 12 mos
96
Q

When does oral candidiasis often occur?

A

After abx therapy

97
Q

Etiology of oral candidiasis

A

Candida albicans

98
Q

Presentation of oral candidiasis

A

Adherent white curd-like plaques that brush off (no fever or other signs of systemic toxicity)

99
Q

Management for oral candidiasis

A

Nystatin oral suspension

100
Q

What is a highly contagious viral illness?

A

Mumps virus (infectious 3 days prior and 9 days after sxs)

101
Q

Initial symptoms of mumps

A

Fever, HA, myalgia, fatigue, anorexia

Within 48 hours, parotitis develops

102
Q

Complications of mumps

A

Orchitis or oophoritis
Neurological complications (meningitis, encephalitis, deaf)
Arthritis, pancreatitis, myocardial involvement

103
Q

Most common ages for parotitis

A

2-9

104
Q

Sxs of parotitis

A

Salivary gland swelling (can last 10 days)

Orifice of Stensen’s duct is erythematous and enlarged

105
Q

Tx for parotitis

A

Supportive care (acetaminophen, cold or warm packs)

X Pediatrics Exam 2 (3 decks)

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