HEENT Flashcards
Head growth 0-3 months (cm)
2 cm/month
Head growth 4-6 months (cm)
1 cm/month
Head growth 6-12 months (cm)
0.5 cm/month
Head growth _____cm/year from 2-7 years; ____cm/year 8-12 years.
0.5 cm/year … 0.3cm/year
Primary microcephaly
Familial and genetic etiologies
Secondary microcephaly
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.
Microcephaly management
Most etiologies untreatable. Thorough H&P to identify treatable causes - hypopituitarism, metabolic disorder, severe malnutrition.
Obstructive hydrocephalus
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.
Nonobstructive hydrocephalus
Impairment of reabsorption of CSF in subarachnoid space - usually secondary to hemorrhage or meningitis.
Physical findings in infant hydrocephalus
Bulging fontanel "Setting sun sign" Separated sutures Hypotonia Hyperreflexia Slow PERRL
Caput succedaneum
Diffuse swelling of infant scalp, crosses suture lines
Caput succedaneum complications
May require phototherapy for hyperbilirubinemia if extensive
Cephalohematoma
Subperiosteal collection of blood; does not cross suture lines - no ecchymosis
Cephalohematoma resolution
Usually spontaneous over days to weeks
May prolong jaundice
May calcify into bony prominence
Suture lines close at _________ (age)
2-3 years
Palpable bony ridge along a suture line
Found over affected suture line in craniosynostosis and indicates premature fusion
Opthalmia Neonatorum (definition)
Infection and/or inflammation of conjunctiva in first month of life
Opthalmia Neonatorum (pathogens)
Chlamydia trachomatis (MOST COMMON) N. gonorrhoea Herpes Staph Strep M. cat Klebsiella Pseudomonas
Most common cause of neonatal conjunctivitis
Chlamydia trachomatis
Acute, profuse, purulent conjunctival discharge 2-4 days after birth with lid edema
N. gonorrhoea
Mild mucopurulent conjunctival discharge presenting 5-14 days after birth
Chlamydia trachomatis
Gonococcal conjunctivitis
OCULAR EMERGENCY!! Admit immediately for IV antibiotics; irrigate eye to remove discgmharge and treat with IM ceftriaxone (unless jaundiced) or IV cefotaxime.
Treatment of Chlamydia conjunctivitis
Oral erythromycin - treats conjunctivitis and may prevent subsequent pneumonia
Conjunctivitis-otitis syndrome
Concurrent infections, typically if ipsilateral eye and ear
Very common
Usually H. influenzae
Bacterial conjunctivitis - Pathogens
Staph aureus
Strep pneumo
M catarrhalis
H. flu
Conjunctivitis with corneal involvement
Refer to opthalmologist
Dacryostenosis
Incidence and resolution
30% incidence
90% resolve by 12 months
Chalazion + definition
noninfectious obstruction of a meibomian gland causing extravasation of irritating lipid material in the eyelid soft tissues with focal secondary granulomatous inflammation
Chalazion - management
Warm compresses
May require incision and curettage if persists beyond several weeks
Hordeolum definition
Acute infectious inflammation of eyelash follicle, aka stye
Blepharitis
Acute or chronic inflammation of bilateral eyelid margins
Blepharitis treatment
Hot compresses
Daily mechanical scrubbing and cleaning with q-tips or soft cloth
Topical antibiotic ointment (sulfacetamide or bacitracin)
Hordeolum pathogen
Most often staph aureus
Hordeolum treatment
Warm compresses
Sulfacetamide or bacitracin ointment
HYGIENE
Orbital cellulitis
Typically secondary to sinusitis, more common in older children (average age 12 years)
EMERGENT due to possible complications, requires hospitalization
Orbital cellulitis- signs and symptoms
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
Cataract - physical findings
Strabismus may be first sign
Absent red reflex - leukocoria, black dot surrounded by red reflex, opacities
Decreased acuity
Congenital glaucoma = that occurring in first _______ _______ of life. More common in (male/female)
First three years
Males
Physical findings of glaucoma
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
Tropia
Misalignment of eyes that is ALWAYS present
Ie. exotropia or esotropia
Phoria
Misalignment of eyes that is only present when binocular vision is disrupted
P is for Part of the time
Amblyopia
Decreased vision secondary to Central suppression of visual input from one eye - adaptive response to untreated strabismus to eliminate diplopia
Strabismus
Definition and incidence
Misalignment of eyes
Blanket term including tropias and phorias
Affects 4% of children < 6yoa
Intermittent exotropia during first 4 to 6 months of life
Normal variant
Strabismus after 4 months of age
REFER
Fixed or constant stabismus at any age
REFER!
Hypertropia or hypotropia
Upward and downward strabismus
REFER!!
Congenital esotropia treatment
Usually surgical repair between 6mos and 2 years
Patching, eyeglasses, dilation of good eye may be used
Mild nystagmus during first few days of life
Normal variant
Passing vision screen
__/__ for children 3-4 years
__/__ for older children
20/40
20/30
Quivering iris
Lens dislocation
Corneal abrasion
Diagnosis and treatment
Fluorescein stain and woods lamp
Topical abx ointment/drops and NSAIDS (topical ketorolac or PO NSAID)
Hyphema
Accumulation of blood in anterior chamber
Hyphema management
Refer to optho, may require hospitalization and surgery
Supine bedrest and eye patching for protection
Hyphema complications
Primarily rebleed, especially with sickle cell
Glaucoma, cataracts and sympathetic ophthalmia possible
Otitis Externa pathogens
Pseudomonas MOST COMMON Staph aureus Strep pyogenes Klebsiella Fungus Staph epidermis Proteus Enterobacter
OE treatment
Topical drops - fluoroquinalone, neomycin or polymyxin; add hydrocortisone if edemetous
Abx saturated cotton wick for first 24-48 hours if significant edema
Systemic abx use for OE
If fever, facial cellulitis or lymphadenitis present
Swimmer’s ear prevention
Instill 50/50 mixture of white vinegar and rubbing alcohol after swimming
Earplugs while swimming
Natural history of untreated AOM
70-90% will spontaneously resolve
Fever incidence in AOM
30-50%
AOM referral to otolaryngology
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
Mastoiditis
AOM complication - requires prompt referral to ENT and IV antibiotics
Cholesteatoma
Cyst-like growth in lining of middle ear filled with desquamated debris
Cause of cholesteatoma
Most common cause of acquired type is chronic OME
May also be congenital
Pearly white opacity on or behind TM
Most likely cholesteatoma
May have history of chronic OM with foul smelling otorrhea
Mild hearing loss = ____dB
15-30 dB
Moderate hearing loss = ____dB
30-50 dB
Severe hearing loss = ____dB
50-70 dB
Profound hearing loss = ____dB
> 70 dB
Congenital sensorineural hearing loss
Causes
Genetic TORCH infections, particularly CMV and rubella Erythroblastosis fetalis Anoxia Exposure to ototoxic drugs
Acquired sensorineural hearing loss
Causes
Meningitis Mumps, measles Noise-induced hearing loss Severe trauma Ototoxic drugs
First line therapy for allergic rhinitis
Allergen avoidance
Chronic rhinitis
chronic nasal discharge, with or without acute exacerbation
May be due to underlying disorder, FB, CF, nasal polyps, infection, allergy, or congenital malformation
Epistaxis - etiology
Most cases benign secondary to increased vascularity
Assess for recurrent episodes, other bleeding, petechiae, family history
Epistaxis referral
If recurrent or severe, or with hematoma, refer to ENT
Acute sinusitis duration
10-30 days
Chronic sinusitis duration
> 30 days
Acute Sinusitis pathogens
S. pneumoniae, H. influenzae, M. catarrhalls
Chronic Sinusitis pathogens
GABHS, S. aureus
Complications of sinusitis
orbital cellulitis, intracranial abcess, osteomyelitis
Most common cause of an abnormal pupillary reflex
cataracts
Diseases associated with cataracts
Diabetes, Marfan syndrome, and atopic dermatitis
Classic triad of pediatric galucoma
tearing, photophobia, and excessive blinking
Etiology of retinopathy of prematurity
Hypovascularized retina is slow to develop blood supply with high oxygen administration
ROP referral criteria
All infants < 30 weeks gestation or <1500g
29-34 weeks or >1500g with unstable hospital course
within two weeks of NICU discharge
Management of gonococcal conjunctivitis
IM cephtriaxone
If hyperbilirubinemia present, use cefotaxime
If extraocular manifestation present, 7d course of IV abx
Management of C. trachomatis conjunctivits
Systemic erythromycin to prevent pneumonia sequelae
Keratitis with corneal ulcer
OCULAR EMERGENCY
refer immediately
may be caused by HSV, bacteria, VZV, HCV
Trachoma
second leading cause of blindness worldwide, though rare in US
Caused by second biovar of C. trachomatis
Auditory brainstem response audiometry
Measures brainstem response to tones
requires sedation beyond about 6 months
Ototoxic drops
Neomycin
Polymyxin
Hydrocortisone
Domebro (acetic acid)
