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primary care midterm > HEENT- Peds > Flashcards

HEENT- Peds Flashcards

1
Q

Mononucleosis: s/s

A
  • Often begins with malaise, headache and low-grade fever before more specific sx develop
    o Tonsillitis/pharyngitis
    o Cervical LAD (typically posterior/occipital)
    o Moderate to high fever
    o Fatigue
  • LUQ abdominal pain
    o Splenomegaly
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2
Q

Mononucleosis: supportive care

A

o Ibuprofen with food for swollen lymph nodes
o Warm compresses
o Rest
o Avoid contact sports d/t hepatomegaly
o Avoid sharing saliva: kissing, sharing utensils, sharing water bottles, etc…
o If co-contaminant strep A, do not treat with Amox/Penicillin: will develop a full body rash

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3
Q

If patient has both strep A and mono DO NOT TREAT WITH abx.. why?

A

full body rash will develop

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4
Q

Epiglottis: s/s

A

o Present with respiratory distress, anxiety, tripoding/sniffing posture (leaning forward at the trunk, hyperextending their neck/chin to maximize their obstructed airway).
o They may be reluctant to lay down
o Drooling is often present, but not always necessary
o Typically Hib

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5
Q
  • Acute epiglottitis
A

o Above symptoms with accompanied acute onset, fever and stridor and hot potato (muffled) voice

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6
Q

tx of epiglottis

A

o Ensure no airway obstruction (intubate if necessary)
o Imaging: x-ray/CT (looking for Thumb sign)
o No laying down flat
o IV steroids
o ? IV antibiotics
o O2

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7
Q

PFAPA Syndrome: Periodic Fever with Aphthous Stomatitis, Pharyngitis, and Adenitis

A
  • Fever begins abruptly with/without chills
  • Prodrome: malaise, irritability, mood changes, sore throat or aphthous ulcers may occur during the preceding day. Fever ranges from 38.5C-41C for 2-7 days, then normalizes.
  • Atypical symptoms: cough, inflamed nostrils, severe abdominal pain, vomiting/diarrhea, chest pain, rash, arthritis or significant neuromuscular symptoms
  • Episodes last no greater than 7 days
  • Periodic fever is the hallmark of PFAPA syndrome
  • There is NO diagnostic lab test for PFAPA; it is based strictly on clinical hx and PE.
  • Abnormal labs during flares potentially: leukocytosis, elevated ESR/CRP, neutrophilia, monocytosis and mild lymphopenia can be noted during flares, but normalize between attacks.
  • You have to rule out other things to rule this in: strep, lyme, IBD, EBV, cyclic neutropenia.
  • Careful documentation of the dates of fever episodes and PE during flares are IMPERATIVE for proper diagnosis.
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8
Q
  • Primary features of PFAPA
A

o More than 3 documented stereotypical episodes of fever occurring at regular intervals
o Intervals between attacks are typically 2-8 weeks.
o Each episode lasts approximately 2-7 days

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9
Q
  • Treatment of PFAPA
A

o Tylenol/Ibuprofen
o Fluids
o Rest
o 1-2mg/kg (max dose 60mg) PO Prednisolone given as a single dose OR 2 doses 12-48 hours apart

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10
Q

mumps

A
  • Viral illness; affects saliva
    *puffy/swollen cheeks
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11
Q

mumps: tx

A
  • No definitive treatment: 1-2 weeks of symptoms typically; supportive treatment
    o Rest
    o Push fluids
    o Tylenol/Ibuprofen (do not give aspirin to anyone under 16 years old)
    o Warm/cool compresses
    o Sucking on sour/lemon candy can help increase salivation which could help relieve some pressure from the parotid gland
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12
Q

mumps s/s

A
  • Typically starts with a few days of: fever, headache, muscle aches, fatigue and loss of appetite, followed by swelling of their salivary glands
    o This causes the jaw/cheek to become puffy/tender and a swollen jaw
    o Parotitis: inflamed parotid gland
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13
Q

Stomatitis: Oral Mucositis

A
  • Inflammation of the mouth; causes swelling and sores inside the mouth
  • Post-viral (HFMD, HSV, Apthous Ulcers)
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14
Q

tx for stomatitis

A
  • Push Fluids
  • Tylenol/Ibuprofen
  • “Magic mouthwash” combination of:
    o Maalox
    o Diphenhydramine
    o Viscous Lidocaine
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15
Q

Peritonsillar Abscess/Retropharyngeal Abscess: s/s

A

o Rapid onset sore throat
o Unilateral
o With/without fever
o Can have neck swelling and referred ear pain

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16
Q

Peritonsillar Abscess/Retropharyngeal Abscess: presentation

A

o Tripoding
o Trismus
o potatoe/muffled voice
o unable to tolerate secretions

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17
Q

Peritonsillar Abscess/Retropharyngeal Abscess: exam

A

o Trismus
o Potato/muffled voice
o Extremely swollen/fluctuant unilateral tonsil with or without exudate
o Deviation of uvula to opposite side
o Erythematous pharynx

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18
Q

Peritonsillar Abscess/Retropharyngeal Abscess: tx

A

o Intra-oral Ultrasound
o Refer to ED for I&D and
* Augmentin: 45mg/kg/dose (max 875mg/dose) BID x 10 days
* Clindamycin: 10mg/kg/dose (max 600mg/dose) QID x 10 days

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19
Q

acute pharyngitis: tx

A
  • Tylenol/Ibuprofen with food for pain/swelling
  • Push fluids
  • Warm salt water gargles
  • Tea with honey and lemon
  • Lozenges or Cepacol throat spray
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20
Q

acute pharyngitis: diagnosis

A

Modified Centor Criteria Score:
* fever: 1
* tonsillar exudate: 1
* absent cough: 1
* anterior cervial LAD: 1
* age 3-14 yrs: 1
* age 15-44 yrs: 0
* age > 44 yrs: -1

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21
Q

Streptococcal Pharyngitis: tx

A
  • First line therapy
    o Amoxicillin: 50mg/kg BID x 10 days (max 1gm/day)
  • If Penicillin/Amoxicillin allergy
    o Cephalexin: 40mg/kg/day divided BID x 10 days (max 500mg/dose)
    o Azithromycin: 12mg/kg/day (max 500mg/day) x 5 days
    o Clindamycin: 7mg/kg/dose (max 300mg/dose) TID x 10 days
  • Ensure they change their toothbrush, wash pillowcases/towels/etc… after 24 hours on antibiotics.
22
Q

Mastoiditis: s/s

A

o Postauricular tenderness
o Erythema
o Swelling
o Fluctuance or mass
o Protrusion of the auricle
o Ear pain, which is a nonspecific finding and may manifest as irritability in young children

23
Q

Mastoiditis: tx

A

This should be ED referral, as they likely need to be admitted for aggressive IV antibiotics and potential surgery.

24
Q

Otitis Externa (Swimmer’s Ear)

A
  • Inflammation/infection of the external ear canal
    o Often will be associated with tragal tenderness
    o Green/black discharge in the edematous/erythematous canal
25
Q

Otitis Externa (Swimmer’s Ear): tx

A

o Ciprodex (Ciprofloxacin 0.3% and dexamethasone 0.1% otic solution): 2 drops QID x 7 days
o Cortisporin (Neomycin 0.35%, polymyxin B 10,000units/mL, and hydrocortisone 0.5% otic solution)
 Considering placing a wick if extremely swollen to allow for more drops to get into the ear
 Rule out concern for mastoiditis

26
Q

chronic otitis media

A
  • Clear fluid in the Tympanic Membrane
  • Feels pressure/pain
  • Often associated with seasonal allergies.
27
Q

chronic otitis media: tx

A

o Claritin/Zyrtec (5mg QAM)
o Flonase nasal spray (1 squirt in each nostril twice daily)
o Benadryl (1mg/kg) at night before bed
o Vicks vapoRub/peppermint oil behind the ears to help open the eustachian tube; fluid will drain down the throat.

28
Q

acute otitis media: age limits

A
  • Children over 2 years of age with a fever, treat; if afebrile, can watch and wait and discuss this with caregivers
  • Children under 6 months-2 years, treated if infection
  • If 2 years old or under, treat for 10 days
    o If not responding to amox after 48-72 hours, switch to augmentin
  • Tougher on the GI system
  • Can start with Augmentin in hx of resistant AOM to amox or with co-contaminant purulent conjunctivitis or if on amox in the past 30 days.
29
Q

acute otitis media: first line tx

A
  • First line: Amoxicillin 80-90mg/kg
    o Augmentin: 90mg/kg per day of amox and 6.4mg/kg per day of clavulanate divided BID (max 3gm/day)
  • Alternatives for penicillin allergy:
    o Cefdinir/Omnicef (once or twice daily dosing): 14mg/kg/day divided BID (max 600mg/day)
    o Ceftriaxone: 50mg/kg (max 1 gm/day) IM QD 1-3 days
    o Azithromycin: 10mg/kg per day orally (max 500mg/day) on day one, then 5mg/kg per day orally (max 250mg/day) days 2-5
    o Clindamycin: 20-30mg/kg divided TID (max 1.8g daily
30
Q

Perforated Tympanic Membrane

A
  • Can happen d/t infection or trauma (loud noises, loud music, explosions, q-tips in the ear)
31
Q

Perforated Tympanic Membrane: tx

A
  • Oral therapy recommended d/t ototoxicity of drops
    o Amoxicillin 90mg/kg/day divided BID x 10 days
    o Augmentin 90mg/kg per day of Amoxicillin and 6.4mg/kg per day of clavulanate divided BID x 10 days.
    o Cefdinir: 14mg/kg per day in 1-2 doses (max 600mg/day)
    o Ceftriaxone: 50mg/kg IM once per day (max 1g/day) for 1-3 doses
    o Azithromycin: 10mg/kg/day (max 500mg) on day 1, then 5mg/kg/day (max 250mg) on days 2-5
    o Clindamycin: 20-30mg/kg/day divided TID (max 1.8g/day)
32
Q

Special Considerations

A
  • 4 or more ear infections in 6 months OR 5 or more ear infections in 12 months
  • If a child has cochlear implant, treat with Augmentin to target H. influenzae.
33
Q
  • Allergic/Viral conjunctivitis
A

o Allergic/Viral/Bacterial
o If associated URI symptoms, likely viral/allergic
o Allergic: clear discharge from eyes
* Antihistamines: Zyrtec/Claritin 5mg PO QD
* Zaditor eye drops: 1 drop in each eye BID
* Benadryl at night before bed

34
Q

Viral/Bacterial Conjunctivitis

A

can both have crusting/mucopurulent discharge
o Erythromycin ointment (1 thin ribbon four times daily) x 5-7 days
* The easiest for pedi patients (drops can work, but they often cause burning/stinging temporarily, which is not ideal for pedi patients)
* Can cause temporary blurriness
* Avoid touching eyes (tough in children)
* Contagious for 24 hours, once starting treatment; after 24 hours of treatment, please wash pillowcases, towels, etc….
* Trimethoprim-Polymyxin B drops (1-2 drops four times daily) x 5-7 days

35
Q

Traumatic Hyphema

A
  • Blood in the anterior chamber of the eye
36
Q

Traumatic Hyphema: hx

A

vision loss, eye pain, nausea and vomiting, blunt trauma
o Rule out orbital compartment syndrome or open globe
o Needs Intraocular pressure done

37
Q

Traumatic Hyphema: PE

A

visual acuity, pupillary response, extraocular movement, visual fields by confrontation, slit lamp, direct fundoscopic exam

38
Q

Traumatic Hyphema: tx

A
  • Requires a head CT and ENT
39
Q

corneal abrasion

A
  • Superficial scratch on the cornea
    o Caused by some irritant/scratch on eye
  • Contact lens wearer, makeup,
  • Getting something into eye
  • Foreign body sensation even once the object is removed
  • With/without photophobia
  • Increased lacrimation
  • Inability to open eye fully
  • Pain even with the eye closed/blinking
    o Fluorescein stain can confirm (can add Tetracaine drops as well
40
Q

corneal abrasion: tx

A

o Avoid direct contact with light (sunglasses)
o Avoid wearing contacts/makeup
o If significantly large, may require a corneal patch (refer to Ophthalmologist/Optometrist)
o If contact wearer tx:
* Ofloxacin drops: 2 drops QID x 7 days
o If not a contact lens wearer:
* Erythromycin ointment: 3-4 applications QID x 5-7 days

41
Q

Retinoblastoma

A
  • Most common type of eye cancer in children; rare cancer, most common in children 5<; can be inherited
42
Q

Retinoblastoma: s/s

A

o A white color in the center circle of the eye (pupil) when light is shone in the eye, such as when someone takes a flash photograph of the child
o Eyes that appear to be looking in different directions
o Poor vision
o Eye redness
o Eye swelling
o Absence of red reflex
o Often caught with families taking pictures with cameras/cell phones

43
Q

Primary Infantile Glaucoma

A
  • Characterized by a progressive optic neuropathy, manifested by cupping of the optic disc, and usually, but not always, associated with increased intraocular pressure (IOP)
  • Onset within the first YOL
  • First sign, peripheral vision loss and if not treated can lead to central vision loss
  • Early diagnosis and referral and necessary for optimal treatment/timely outcomes
    o Refer to the ED
44
Q

Preseptal/Orbital Cellulitis: s/s

A
  • Infection surrounding the orbit (posterior to the orbit)
  • Pain with eye movement
  • Proptosis
  • Ophthalmoplegia
45
Q

Preseptal/Orbital Cellulitis: tx

A

o Refer to the ED for IV antibiotics (Vancomycin/Ceftriaxone)

46
Q

nasal trauma

A
  • Stop the bleeding
  • Concern for concussion/LOC
  • Rule out a fracture
    o Deviated septum
    o Patency of nares
  • Refer to Pedi ENT
47
Q

foreign body

A
  • Can try to grab with alligator forceps/clamps
  • Close unaffected nostril; have parent blow into the patients mouth very forcefully
  • Fogarty Balloon
    o Insert the catheter past/through the object, then inflate the balloon and pull out
48
Q

Epistaxis (Nosebleed)

A
  • How long have they been bleeding?
  • Hx of bleeding disorder?
  • Trauma?
  • Hot/dry air (common in winter d/t forced hot air and summer with AC’s)
49
Q

Epistaxis (Nosebleed): tx

A

o Pressure
o Ice (Nose Buddy)
o Nasal saline/Ayr gel/humidifier in room
o Refer for Heme workup if constant and lasting greater than 20 minutes

50
Q

sinusitis

A
  • With/without fever
  • Timeline
  • Other symptoms
51
Q

sinusitis: tx

A

o Claritin/Zyrtec (5mg QD)
o Flonase
o Benadryl at night before bed
o Saline rinses/Neti pots
o Augmentin: 45 mg/kg/day (max 1.75g/day) divided BID x 10 days
o Cefdinir: 14mg/kg/day (max 600mg/day) divided BID x 10 days
o Levofloxacin: 10-20mg/kg/day (max 500mg/day) divided BID x 10 days

primary care midterm (12 decks)

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