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PNP Board Review > HEENT > Flashcards

HEENT Flashcards

1
Q

Head growth 0-3 months (cm)

A

2 cm/month

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2
Q

Head growth 4-6 months (cm)

A

1 cm/month

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3
Q

Head growth 6-12 months (cm)

A

0.5 cm/month

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4
Q

Head growth _____cm/year from 2-7 years; ____cm/year 8-12 years.

A

0.5 cm/year … 0.3cm/year

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5
Q

Primary microcephaly

A

Familial and genetic etiologies

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6
Q

Secondary microcephaly

A

Acquired from multiple noxious causes that may affect the infant in utero or during first 2 years of life; i.e., fetal exposure to infection, substances, radiation; extreme poor nutrition, placental insufficiency, trauma, maternal hypoglycemia.

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7
Q

Microcephaly management

A

Most etiologies untreatable. Thorough H&P to identify treatable causes - hypopituitarism, metabolic disorder, severe malnutrition.

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8
Q

Obstructive hydrocephalus

A

Major cause, involves obstruction of CSF flow within ventricular system. May be congenital malformation, associated with syndrome (dandy-walker, Arnold-chiari), or acquired from space occupying lesson.

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9
Q

Nonobstructive hydrocephalus

A

Impairment of reabsorption of CSF in subarachnoid space - usually secondary to hemorrhage or meningitis.

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10
Q

Physical findings in infant hydrocephalus

A 
Bulging fontanel
"Setting sun sign"
Separated sutures
Hypotonia
Hyperreflexia
Slow PERRL
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11
Q

Caput succedaneum

A

Diffuse swelling of infant scalp, crosses suture lines

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12
Q

Caput succedaneum complications

A

May require phototherapy for hyperbilirubinemia if extensive

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13
Q

Cephalohematoma

A

Subperiosteal collection of blood; does not cross suture lines - no ecchymosis

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14
Q

Cephalohematoma resolution

A

Usually spontaneous over days to weeks
May prolong jaundice
May calcify into bony prominence

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15
Q

Suture lines close at _________ (age)

A

2-3 years

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16
Q

Palpable bony ridge along a suture line

A

Found over affected suture line in craniosynostosis and indicates premature fusion

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17
Q

Opthalmia Neonatorum (definition)

A

Infection and/or inflammation of conjunctiva in first month of life

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18
Q

Opthalmia Neonatorum (pathogens)

A 
Chlamydia trachomatis (MOST COMMON)
N. gonorrhoea
Herpes
Staph
Strep
M. cat
Klebsiella
Pseudomonas
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19
Q

Most common cause of neonatal conjunctivitis

A

Chlamydia trachomatis

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20
Q

Acute, profuse, purulent conjunctival discharge 2-4 days after birth with lid edema

A

N. gonorrhoea

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21
Q

Mild mucopurulent conjunctival discharge presenting 5-14 days after birth

A

Chlamydia trachomatis

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22
Q

Gonococcal conjunctivitis

A

OCULAR EMERGENCY!! Admit immediately for IV antibiotics; irrigate eye to remove discgmharge and treat with IM ceftriaxone (unless jaundiced) or IV cefotaxime.

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23
Q

Treatment of Chlamydia conjunctivitis

A

Oral erythromycin - treats conjunctivitis and may prevent subsequent pneumonia

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24
Q

Conjunctivitis-otitis syndrome

A

Concurrent infections, typically if ipsilateral eye and ear

Very common

Usually H. influenzae

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25
Q

Bacterial conjunctivitis - Pathogens

A

Staph aureus
Strep pneumo
M catarrhalis
H. flu

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26
Q

Conjunctivitis with corneal involvement

A

Refer to opthalmologist

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27
Q

Dacryostenosis

Incidence and resolution

A

30% incidence

90% resolve by 12 months

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28
Q

Chalazion + definition

A

noninfectious obstruction of a meibomian gland causing extravasation of irritating lipid material in the eyelid soft tissues with focal secondary granulomatous inflammation

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29
Q

Chalazion - management

A

Warm compresses

May require incision and curettage if persists beyond several weeks

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30
Q

Hordeolum definition

A

Acute infectious inflammation of eyelash follicle, aka stye

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31
Q

Blepharitis

A

Acute or chronic inflammation of bilateral eyelid margins

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32
Q

Blepharitis treatment

A

Hot compresses
Daily mechanical scrubbing and cleaning with q-tips or soft cloth
Topical antibiotic ointment (sulfacetamide or bacitracin)

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33
Q

Hordeolum pathogen

A

Most often staph aureus

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34
Q

Hordeolum treatment

A

Warm compresses
Sulfacetamide or bacitracin ointment
HYGIENE

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35
Q

Orbital cellulitis

A

Typically secondary to sinusitis, more common in older children (average age 12 years)

EMERGENT due to possible complications, requires hospitalization

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36
Q

Orbital cellulitis- signs and symptoms

A

Key= proptosis and opthalmoplegia (⬇️ EOM)

Insidious onset of unilateral lid edema and redness - not extending into eyebrow

Orbital pain and headache

Decreased vision and EOM

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37
Q

Cataract - physical findings

A

Strabismus may be first sign
Absent red reflex - leukocoria, black dot surrounded by red reflex, opacities
Decreased acuity

38
Q

Congenital glaucoma = that occurring in first _______ _______ of life. More common in (male/female)

A

First three years

Males

39
Q

Physical findings of glaucoma

A 
Increased IOP - may be appreciated on palpation
Epiphora (abnormal overflow of tears)
Blepharospasm
ENLARGED CORNEA >10mm
Tunnel vision
Ocular pain
IRREGULAR CORNEAL REFLEX
Corneal haziness or edema
Cupping of optic disc
40
Q

Tropia

A

Misalignment of eyes that is ALWAYS present

Ie. exotropia or esotropia

41
Q

Phoria

A

Misalignment of eyes that is only present when binocular vision is disrupted

P is for Part of the time

42
Q

Amblyopia

A

Decreased vision secondary to Central suppression of visual input from one eye - adaptive response to untreated strabismus to eliminate diplopia

43
Q

Strabismus

Definition and incidence

A

Misalignment of eyes

Blanket term including tropias and phorias

Affects 4% of children < 6yoa

44
Q

Intermittent exotropia during first 4 to 6 months of life

A

Normal variant

45
Q

Strabismus after 4 months of age

A

REFER

46
Q

Fixed or constant stabismus at any age

A

REFER!

47
Q

Hypertropia or hypotropia

A

Upward and downward strabismus

REFER!!

48
Q

Congenital esotropia treatment

A

Usually surgical repair between 6mos and 2 years

Patching, eyeglasses, dilation of good eye may be used

49
Q

Mild nystagmus during first few days of life

A

Normal variant

50
Q

Passing vision screen

__/__ for children 3-4 years
__/__ for older children

A

20/40

20/30

51
Q

Quivering iris

A

Lens dislocation

52
Q

Corneal abrasion

Diagnosis and treatment

A

Fluorescein stain and woods lamp

Topical abx ointment/drops and NSAIDS (topical ketorolac or PO NSAID)

53
Q

Hyphema

A

Accumulation of blood in anterior chamber

54
Q

Hyphema management

A

Refer to optho, may require hospitalization and surgery

Supine bedrest and eye patching for protection

55
Q

Hyphema complications

A

Primarily rebleed, especially with sickle cell

Glaucoma, cataracts and sympathetic ophthalmia possible

56
Q

Otitis Externa pathogens

A 
Pseudomonas MOST COMMON
Staph aureus
Strep pyogenes
Klebsiella
Fungus
Staph epidermis
Proteus
Enterobacter
57
Q

OE treatment

A

Topical drops - fluoroquinalone, neomycin or polymyxin; add hydrocortisone if edemetous
Abx saturated cotton wick for first 24-48 hours if significant edema

58
Q

Systemic abx use for OE

A

If fever, facial cellulitis or lymphadenitis present

59
Q

Swimmer’s ear prevention

A

Instill 50/50 mixture of white vinegar and rubbing alcohol after swimming

Earplugs while swimming

60
Q

Natural history of untreated AOM

A

70-90% will spontaneously resolve

61
Q

Fever incidence in AOM

A

30-50%

62
Q

AOM referral to otolaryngology

A

Persistent AOM resistant to treatment over 1-2 months
Recurrent AOM, 3 in 6 months or 4-5 in 12 months
Chronic OME >3 months
Evidence of hearing impairment or language delay

63
Q

Mastoiditis

A

AOM complication - requires prompt referral to ENT and IV antibiotics

64
Q

Cholesteatoma

A

Cyst-like growth in lining of middle ear filled with desquamated debris

65
Q

Cause of cholesteatoma

A

Most common cause of acquired type is chronic OME

May also be congenital

66
Q

Pearly white opacity on or behind TM

A

Most likely cholesteatoma

May have history of chronic OM with foul smelling otorrhea

67
Q

Mild hearing loss = ____dB

A

15-30 dB

68
Q

Moderate hearing loss = ____dB

A

30-50 dB

69
Q

Severe hearing loss = ____dB

A

50-70 dB

70
Q

Profound hearing loss = ____dB

A

> 70 dB

71
Q

Congenital sensorineural hearing loss

Causes

A 
Genetic 
TORCH infections, particularly CMV and rubella
Erythroblastosis fetalis
Anoxia
Exposure to ototoxic drugs
72
Q

Acquired sensorineural hearing loss

Causes

A 
Meningitis
Mumps, measles
Noise-induced hearing loss
Severe trauma
Ototoxic drugs
73
Q

First line therapy for allergic rhinitis

A

Allergen avoidance

74
Q

Chronic rhinitis

A

chronic nasal discharge, with or without acute exacerbation

May be due to underlying disorder, FB, CF, nasal polyps, infection, allergy, or congenital malformation

75
Q

Epistaxis - etiology

A

Most cases benign secondary to increased vascularity

Assess for recurrent episodes, other bleeding, petechiae, family history

76
Q

Epistaxis referral

A

If recurrent or severe, or with hematoma, refer to ENT

77
Q

Acute sinusitis duration

A

10-30 days

78
Q

Chronic sinusitis duration

A

> 30 days

79
Q

Acute Sinusitis pathogens

A

S. pneumoniae, H. influenzae, M. catarrhalls

80
Q

Chronic Sinusitis pathogens

A

GABHS, S. aureus

81
Q

Complications of sinusitis

A

orbital cellulitis, intracranial abcess, osteomyelitis

82
Q

Most common cause of an abnormal pupillary reflex

A

cataracts

83
Q

Diseases associated with cataracts

A

Diabetes, Marfan syndrome, and atopic dermatitis

84
Q

Classic triad of pediatric galucoma

A

tearing, photophobia, and excessive blinking

85
Q

Etiology of retinopathy of prematurity

A

Hypovascularized retina is slow to develop blood supply with high oxygen administration

86
Q

ROP referral criteria

A

All infants < 30 weeks gestation or <1500g
29-34 weeks or >1500g with unstable hospital course
within two weeks of NICU discharge

87
Q

Management of gonococcal conjunctivitis

A

IM cephtriaxone
If hyperbilirubinemia present, use cefotaxime
If extraocular manifestation present, 7d course of IV abx

88
Q

Management of C. trachomatis conjunctivits

A

Systemic erythromycin to prevent pneumonia sequelae

89
Q

Keratitis with corneal ulcer

A

OCULAR EMERGENCY
refer immediately
may be caused by HSV, bacteria, VZV, HCV

90
Q

Trachoma

A

second leading cause of blindness worldwide, though rare in US
Caused by second biovar of C. trachomatis

91
Q

Auditory brainstem response audiometry

A

Measures brainstem response to tones

requires sedation beyond about 6 months

92
Q

Ototoxic drops

A

Neomycin
Polymyxin
Hydrocortisone
Domebro (acetic acid)

PNP Board Review (5 decks)

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