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Pediatrics 2 > HEENT > Flashcards

HEENT Flashcards

1
Q

Allergic conjunctivitis

- sx

A
  • bilateral
  • watery, red, itchy
  • PND, cough, runny nose, allergy sx
  • Clear discharge
  • none-mild eyelid edema
  • no lymphadenopathy
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2
Q

Allergic conjunctivitis

- treatment

A
  • Eye drops

- oral antihistamines

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3
Q

Viral conjunctivitis

- sx

A
  • uni- or bilateral
  • red, swelling, pain
  • preauricular lymphadenopathy
  • Eyelid edema
  • more pain than allergic
  • clear discharge, mats overnight, thicker than allergic
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4
Q

Viral conjunctivitis

- MC pathogens

A
  • adenovirus MC

- HHV also

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5
Q

Viral conjunctivitis

- Tx

A

supportive

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6
Q

Bacterial conjunctivitis

- sx

A
  • starts unilateral, spreads bilateral
  • Pain, red
  • purulent drainage
  • possible edema but less than viral
  • no lymphadenopathy
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7
Q

Bacterial conjunctivitis

- MC pathogen(s)

A
  • strep pneumonia
  • m. catharrhalis
  • h. influenzae
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8
Q

Bacterial conjunctivitis

- tx

A
  • topical abx (gentamicin, fluoroquinolone)
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9
Q

Orbital cellulitis

  • pathogenesis
  • signs and sx
A
  • untreated sinus infection (maxillary), trauma, foreign body,
  • Eye swollen shut, red
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10
Q

Orbital cellulitis

- MC pathogen

A
  • staph

- also GAS pyogenes

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11
Q

Orbital cellulitis

  • Complications
  • Tx
A
  • brain abscess, meningitis, optic nerve and facial nerve issues
  • IV abx
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12
Q

Strabismus

  • pathogenesis
  • Signs and sx
A
  • muscle weakness around the eye (CN 3,4,6)

- one eye points different direction than the other

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13
Q

___ tropia vs. ___phoria

A
  • tropia: when both eyes are open

- Phoria: when one eye is covered

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14
Q 
Eso-
Exo-
Hyper-
Hypo-
Tropia and phoria
A

Eso: inward
Exo: outward
hyper: upward
hypo: downward

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15
Q

In a blowout fracture, what type of strabismus

A
  • hypotropia: downward

- blowout fx usually at base of orbit

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16
Q

Strabismus

  • dx workup
  • tx
A
  • cover test, look for trauma, hx

- tx: patch if not traumatic, sx if dt trapped nerve/muscle

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17
Q

Acute Otitis Media

  • Pathogenesis
  • Signs and sx
A
  • horizontal eustachian tubes don’t drain as well

- ear pain, pulling on ear, bulging TM, decreased mobility of TM, red, fluid behind TM

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18
Q

Acute Otitis Media

- Risk factors

A
  • *daycare
  • *cigarette smoke
  • *bottle feeding
  • young
  • previous URI/cold
  • Smoking house
  • allgeries
  • ETD
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19
Q

Acute otitis media

- common pathogens

A
  • strep pneumonia
  • h. flu
  • m. cat
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20
Q

Acute otitis media

- Tx

A
  • amoxicillin 80-90 mg/kg/day

- if <24 months will generally treat, if older, can watch and wait if trust parents

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21
Q

Acute otitis media

- prevention

A

pneumococcal vaccination (majority of infections are viral)

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22
Q

Recurrent AOM

- define

A

multiple episodes of AOM separated by intervals of normal middle ear status (no effusion)
- >3 episodes of AOM in 6-12 months

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23
Q

Recurrent AOM

- tx

A
  • Abx prophylaxis, no more than 6 months
  • pneumococcal vaccination
  • Refer to ENT for tubes
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24
Q

Otitis media with effusion

  • define
  • pathogenesis
  • Signs and sx
A
  • inflammation of middle ear resulting in collection of fluid behind intact TM
  • Children: pain, conductive hearing loss, usu bilateral, often have allergies
  • Adult: fullness in ear, popping, crackling, hearing loss
  • TM: air fluid bubble, amber color possible, mucoid
  • TM: bulging, normal, retracted (bones are emphasized)
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25
Q

Otitis media with effusion

- acute onset in adult, what is concern

A

nasopharyngeal tumor

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26
Q

Otitis media with effusion

- dx wu

A

PE

  • serous effusion, mucoid effusion
  • membrane appearance
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27
Q

Otitis media with effusion

- treatment

A
  • Adults and kids: short course oral or nasal steroids to reduce swelling
  • > 3 months, send to ENT for tubes
  • tonsillectomy or adenoidectomy if they are the cause
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28
Q

TM perforation

  • pathogenesis
  • signs and sx
  • risk factors
A
  • AOM, pressure change, slap over ear
  • acute pain, hearing loss
  • AOM, AOM with effusion, barotrauma
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29
Q

TM performation

  • Dx
  • Tx
  • complications
A
  • PE: look in ear
  • Usually self healing, can refer to ENT for tympanoplasty if necessary
  • hearing loss, infection, cholesteatoma
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30
Q

Where does a cholesteatoma form MC?

A

pars flacida

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31
Q

Acute mastoiditis

  • pathogenesis
  • signs and sx
  • risk factors
A
  • commonly dt spread of AOM to mastoid portion of the temporal bone
  • red, swollen mastoid area, ear projects anteriorly
  • AOM
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32
Q

Acute mastoiditis

  • common pathogens
  • DX w/u
  • tx
A
  • strep pyogenes (GAS), pseudomonas, h. flu
  • PE, CT, treat empirically
  • Children often inpatient for IV abx, might need tubes if no improvement
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33
Q

Acute otitis externa

  • pathogenesis
  • signs and sx
A
  • wet ear

- pain, pain with ear manipulation, swelling, purulent discharge

34
Q

Acute otitis externa

  • common pathogen
  • w/u
  • tx
A
  • pseudomonas MC, also staph and other gram neg

- ear debridement, topical abx drops (wick if necessary), oral analgesics

35
Q

Acute otitis externa

- how to tell if fungal vs. bacterial

A

fungal will have black flecks

36
Q

How to tell AOE from AOM if can’t see TM?

A

history!!

AOM more likely if preceding fever

37
Q

Necrotizing otitis externa

  • aka
  • describe
  • pathogenesis
A
  • “malignant otitis externa”
  • severe infection of EAC, EMERGENCY, send to ER
  • often due to trauma (q-tips??), also common in DM and HIV pts
38
Q

Necrotizing otitis externa

- pathogen

A

pseudomonas (fluoroquinolone)

39
Q

Necrotizing otitis externa

- signs and sx

A
  • granulation tissue at bony joint in ear
  • deep ear pain
  • HA
  • purulent drainage
40
Q

Hearing loss in children

A
  • important for speech and language
  • genetic and non-genetic causes
  • Infections during pregnancy, environmental causes, complications after birth = 30% hearing loss
  • 70% non-syndromic, 30% syndromic
  • Screened at birth but sometimes may manifest later in life
  • Gentamycin is ototoxic
41
Q

3 types of hearing loss

A
  • conductive
  • sensorineural
  • mixed
42
Q

Degrees of hearing loss (4)

A
  • mild: can hear some speech, soft sounds are hard to hear
  • moderate: hard to hear normal speech
  • severe: can’t hear speech, can hear loud sounds
  • profound: cannot hear speech, can only hear VERY loud sounds
43
Q

Signs a baby has hearing loss

A
  • does not startle
  • does not turn toward source of sound >6 mo
  • does not say single words by age 1
  • turns head when they see you but not when you call their name
  • seems to hear some sounds but not others
44
Q

Signs a child has hearing loss

A
  • delayed speech
  • unclear speech
  • does not follow directions (??)
  • “huh”?
  • Volume high on devices
45
Q

Hearing loss screening

A
  • infants no later than 1 mo
  • If at risk for acquired, progressive, or delayed onset hearing loss, hearing test by 2-2.5 yo
  • fail hearing screening = audiogram evaluation
46
Q

Treatment for hearing loss

A

no one answer

  • early intervention
  • sign language
  • hearing devices
  • support groups
47
Q

Rhinitis

  • define
  • three main types
A

broad range of inflammatory diseases of the nasal lining

  • acute viral rhinitis
  • allergic rhinitis
  • nonallergic rhinitis with eosinophilia (NARES)
48
Q

Acute viral rhinitis

  • pathogenesis
  • signs and sx
A
  • MC is rhinovirus
  • runny nose, congestion, sneezing, cough, HA, low-grade to no fever
  • mucus is yellow or green (not clear like allergic)
49
Q

Acute viral rhinitis

- risk factors

A
  • day care / school
  • winter (inside)
  • travel
50
Q

Acute viral rhinitis

- tx

A
  • Self limiting, lasts 7-10 days

- Supportive care

51
Q

Allergic rhinitis

  • S and sx
  • risk factors
A
  • runny nose (clear), congestion, watery eyes, PND, itching, cough, sneeze
  • allergic salute and allergic shiners
  • pale and boggy turbinates
  • RF: allergens, fam hx, smoke in house
52
Q

Allergic rhinitis

  • Dx w/u
  • tx
A
  • IgE type 1 hypersensitivity testing

- oral antihistamines, nasal corticosteroids

53
Q

Nonallergic rhinitis w/eosinophilia (NARES)

A
  • paroxysmal sneezing, watery rhinorrhea and clear nasal sx
  • Occurs throughout the entire year
  • negative IgE on allergy testing
  • is a disorder of eosinophil metabolism
54
Q

What is nonallergic rhinitis w/eosinophilia (NARES) associated with?

A
  • asthma
  • aspirin intolerance
  • nasal polyps
55
Q

Nonallergic rhinitis w/eosinophilia (NARES)

- tx

A

nasal steroids or singulair

56
Q

Rhinosinusitis

  • define
  • list and define the three types
A
  • broad spectrum of inflammatory disorders that concomitantly affect both the parental sinuses and nasal cavity
  • Acute: <4 weeks, >10 days
  • Recurrent acute: 4+ episodes in 12 month period with sx free months in between
  • Chronic: >12 weeks with constant sx
57
Q

Rhinosinusitis

- Dx criteria

A
  • 2 major
  • 1 major and 2 minor
  • Facial pain w/o another major nasal ss is NOT RS
  • Fever alone without other major nasal sx is NOT RS
58
Q

Rhinosinusitis

- Major factors

A
  • facial pain/pressure
  • nasal obstruction/blocakge
  • nasal discharge, purulence, discolored PND
  • hyposmia/anosmia
  • purulence in nasal cavity
  • fever (acute RS)
59
Q

Rinosinusitis

- minor factors

A
  • HA
  • Fever
  • halitosis
  • fatigue
  • dental pain
  • cough
  • ear pain/pressure/fullness
60
Q

Acute rhinosinusitis

  • define
  • common pathogens
A
  • purulent rhinorrhea lasting >10 days
  • associated with fever
  • strep pneumo, m. cat, h. flu
61
Q

Acute rhinosinusitis

- tx

A
  • mild: can hold off tx for 48 hours
  • moderate: amoxicillin, then augmenting if strep pneumonia
  • Guaifenesin to thin nasal mucus so can clear, decongestants, nasal rinses
62
Q

Recurrent acute rhinosinusitis

  • contributing factors
  • PE
  • Tx
A
  • immunodeficiency, CF, GERD
  • PE: assess adenoid size, try to figure out why keep recurring
  • treat each acute episode with abx
  • refer to ENT, child may need adenoidectomy
63
Q

Chronic rhinosinusitis

- tx

A
  • 3-6 weeks abx, topical nasal steroids, nasal irrigation
  • ENT, allergist
  • sx only when refractor to standard tx
64
Q

Chronic rhinosinusitis

- complications

A
  • orbital cellulitis
  • meningitis
  • osteomyelitis
65
Q

Epistaxis

  • Anterior
  • Posterior
A
  • Anterior: 80%, Kiesselbach plexus

- Posterior: 20%, sphenopalatine artery (from maxillary)

66
Q

Anterior epistaxis

  • cause
  • PE
  • Tx
A
  • nose picker MC! also dry air
  • look in nose for PE
  • Cauterize with silver nitrate, pack, spray with Afrin, stop anticoagulants for a week if possible, humidifier for prevention
67
Q

Posterior epistaxis

- tx

A
  • posterior nasal packing
68
Q

Tonsillar hypertrophy

  • assoc with what
  • MC manifestation in children
A
  • airway and feeding difficulties

- MC sx is snoring in children

69
Q

Tonsillar grading

A

0: sx removed
1: hidden within pillars
2: extend to pillars
3: beyond pillars
4: kissing uvula (midline)

70
Q

Adenoid hypertrophy

  • define
  • causes what
A
  • lymphoid tissue on posterior pharyngeal wall and roof of nasopharynx, behind soft palate and adjacent to torus tubarius (ET opening)
  • enlargement can = airway issues
  • nasal obstruction, chronic mouth breathing, snoring
  • 2ndary ETD, AOM, sinusitis
71
Q

Acute viral tonsillitis

  • 3 pathogens
  • signs and sx
A
  • EBV (mono)
  • Coxsackie
  • HHV
  • sore throat, rhinorrhea, cough, hoarse, PND
72
Q

Acute bacterial tonsillitis

  • Pathogens
  • S and sx
  • risk factors
A
  • GAS pyrogenes
  • fever, lymphadenopathy and sore throat
  • URI, sick contact, allergies
73
Q

Acute bacterial tonsillitis

- Tx

A
  • Abx: amoxicillin, cephalexin, penicillin V
  • tonsillectomy: 7+ documented strep positive infections in one year, 5+ in previous 2 years, 1 per year last three years
74
Q

Chronic tonsillitis

- describe

A
  • low-grade infection of tonsils
  • large, cryptic tonsils collect food and debris
  • lymphadenopathy d/t tonsillar infection
  • chronic halitosis (retained food/debris)
  • sore throat better on abx, comes back when stop med
75
Q

Chronic tonsillitis - when consider tonsillectomy

A

Have to consider life: if missing work/school, frequent infections, sleep apnea, etc.

76
Q

Peritonsillar cellulitis/abscess

  • describe
  • signs and sx
A
  • tonsillar infection that penetrates the tonsillar capsule, spreads to surrounding tissue, if untreated necrosis occurs and creates abscess
  • high fever, severe sore throat, unilateral tonsils swelling, deviation of uvula, trismus
77
Q

Peritonsillar cellulitis/abscess

- treat

A
  • cellulitis: abx

- Abscess: I and D

78
Q

Retropharyngeal absecess

  • describe
  • s and sx
A
  • the retropharyngeal lymph nodes that drain the adenoids, nasopharynx, and paranasal sinuses become infected, untreated = abscess
  • High fever, SOB, drooling, dyspnea, neck hyperextension
79
Q

Retropharyngeal absecess

- pathogens

A
  • GAS MC

- staph also possible

80
Q

Retropharyngeal absecess

  • dx
  • tx
A
  • history and PE
  • neck film: thickening of prevertebral soft tissue and air fluid levels
  • Admit for IV abx, drain abscess
81
Q

Oral candidiasis

  • MC pathogen
  • s/sx
  • RF
  • Tx
A
  • C. albicans
  • white spots in mouth (maybe on mom’s breast too)
  • Very common in nl infants during first few weeks of life, not common in older children unless they’ve had abx
  • RF: abx, dm, inhalers
  • oral nystatin or gentian violet (mom too)
82
Q

Epiglottitis

  • describe
  • s/sx
  • pathogen
A
  • infection of subraglottic structures
  • Tripodding, respiratory distress
  • strep pneumo
  • XR: thumbprint sign
  • Tx: IV abx, send home on 7-10d oral abx

Pediatrics 2 (7 decks)

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