HEENT X3 Flashcards
Bacterial COnjunctivits Tx
Ointment preferred
Erythromycin ointment
Trimetoprim-polymyxin B drops
*oint may have blurry vision for 20min
Neonatal conjunctivitis
etiology
sx/dx
chlamydia trachomatis
Sx: watery>mucopurulent>bloody
chemosis and pseudomembrane
Dx: NAAT
Neonatal Conjunctivits Tx
Oral erythromycin 50mg/Kg QID for 14days
*cannot use topical!!!
hyperacute bacterial conjunctivits
etiology
presentation
Neisseria gonorrhoeae Sx: 2-5 days after birth profuse purulent discharge chemosis \+/- urethritis
hyperacute bacterial conjunctivitis Tx
Immidiate hospitalization
and opthamologic referall
What are contact lens wearers at risk for?
Pseudomonal keratitis sx of keratitis - foreign body sensation -blepharospasm -visual opacity with penlight *immediate optha referall (12-24) Tx: discontinue lens use -antipseudo abx
Viral Conjunctivitis Tx
topical antihistamines
-naphcon A
Lubricant eye drops
When can children return to school and sports after conjunctivitis
-till no longer discharge, most schools require 24 hours of topical therapy
Viral
-non contact: we they feel okay and can see clearly
-contact/water: when daytime discharge has stopped
Pharm managment of allergic conjunctivitis
- Antihistamine with mast cell stabilizing properties >3yo
olopatadine, azelastine - OTC topical vasoconstrictor and antihistamine <2wk
-naphcon A Visine A - Mast cell stabilizer >4yo
cromolyn opthalmic
- only an opthamologist will prescribe topical glucocorticoids
Kawasaki presentation
small and medium size vessel vasculitis Fever "CRASH" conjunctivits (non exudative) rash (morbilliform) adenopathy (cervial) strawberry tongue hands(red swollen and desquamation) *should be considered in any children with unexplanned fever for >5days
Kawasaki Disease complications
Cadiovascular complications - cornonary aneurysms and carditis Manifestations - tachycardia (greater than you would expect with fever) -gallop -muffled heart tones Dx echocardiogram
What suggests increased risk of cardiac aneurisms c Kawasaki? What will the labs show?
<1 >6 fever >14 serum sodium <135 mEq/L Heatocrit <35% WBC >12000/mm3 Labs ^ESR, thrombocytosis, leukocytosis (Immature neutrophils), normocytic, normochromic anemia, hyponatremia
Tx of Kawasaki
IVIG
High dose asprin
delay vaccines
Strbisumus dx and managment
Dx: abnormal corneal light reflection
conver uncover test will demonstrate deviation
dacrostenosis presentation
Nasolactrimal duct obstruction
-b/c persistant tearing and ocular discharge
Sx: chronic tearing, mucoid discharge, debris on lashes, mild redness of lower lid
dx and tx of dacrostenosis
- most resolve spontaniously
1. Lacrimal sac massage - surgical probe would be definitive
dacryocystitis etiology and presentation
inflamation of lacrimal sac
etiology: staphylococcus
Sx: erythema, swelling, warmth, tenderness of larimal sac, purulent discharge
Tx of dacryocystitis
oral clindamycin (mild)
or
IV vanco and 3rd gen ceph
Most common etiology for acute otitis media
S. Pneumonia
H. influenza
Moraxella catarrhalis
Acute Otitis Media Sx
Sx: otalgia, fever, irritability
PE: Bulding TM with decreased motility
otorrhea erythematous TM
Acute Otitis Media Tx
- Analgesics (ibu/acet)
- high dose amoxicillin 90mg/kg/12hrs
-if no recent B lactam, purulent discharge or rec sx
10day <2 5-7 >2yrs - Augmentent -if the above were met
if PCN allergery cefdinir, azithromycin, clindamycin
Acute otitis Media who gets abx
<6mo severe sx: ^pain, >48hrs, >102.2 Bilateral >2yrs -potentially unilateral <2yrs follow up in 48 hrs
Recurrent AOM prophylaxis
>3 epi in 6 mo >4 per year if fluid noted daily abx in winter - amoxicillin 40mg/kg/day -sulfisoxazole 50mg/kg/day -tubes if they are not effective
Clinical pres of otitis media with effusion
Retracted TM
decreased motility of TM
Otitis externa etiology and sx
P.aeruginosa, s. aureus, s. epidermis
Sx: otalgia, pruitis, discharge
-tragus tenderness,
-erythema of the ear canal
Otitis externa tx
ABx - Cortisporin (not with perf TM) -Floxin -Ciprodex Acidifying solutions -acetic acid *use of ear wick PRN
Allergic Rhinitis pattern of sx and Severity
Intermittent: <4days a week or <4 weeks Persistant: sx> 4 days/week and >4weeks Severity: mod-severe: one or more sleep dist, impair in school, impair in daily act, troublesome sx
Allergic Rhinitis Physical Findings
- Allergic Shiners
- allergic cnjunctivitis
- dennie morgan lines - Allergic salute- crease on nose
- Pale blue boggy nasal mucosa
- Edematous turbinates
- Post Pharynx- cobblestoning
Allergic Rhinitis Pham Tx
- Steroids (first line)
-fluticasone (flonase) - Antihistamines
first gen: diphenhydrmine
sec gen: cetirizine, loratidine
intranasal: azelastine, olopatadine - Decongestants
- Anticholinergics
-ipratropium - Mast Cell Stabilizer
cromolyn - LTR antagonist
-motelukast
SAMTERs Triad
nasal polyps (rare under 10 except CF)
asthma
ASA (asprin) sensitity
Nasal poply clinical finding
- obstruction
- hyponasal speech
- profuse rhinorrhea (on side of polyp)
Nasal Polyp Tx
Decongestants
Intranasal steroid sprays
systemic steroids
surgical removal
Etiology of viral URI
Sx
50% is rhinovirus Sx: non toxic appearance - fever in young children Infants: fever and nasal dicharge School age: nasal congestion, discharge, and cough
Caution with OTC decongestants
Do NOT use in children <6yo probably not in 6-12
- or with conditions ass with serious breathing problems
Antitussives- delay coughing up mucus
Expectorants- increase production/thin to expel which can lead to bronchio spasm or GI disturbance
CLinical presentation of bacterial rhinosinititus
Sx: discharge, or congestion, cough, facial pain, HA, fever
- see erythema of nasal turbinates
mucopurulanet discharge + postnasal drip
Dx for Acute vs. Chronic Rhinosinusitis
Acute: >10<30X-ray or CT
Chronic: (>12wks )
Xray, CT, MR
- maybe culture, Blood work, surgery
Tx Acute Sinusitis
Saline irrigation decongestant- oral/top antihistamines intransal glucocorticoids *if bacterial> augmenten 45mg/kg/day
Chronic sinusitis Tx
saline irrigation
intranasal glucocorticoids
ABx if bacterial
Anti-leukotreine agents
Pharyngitis etiology
Viral-most common
adenovirus and Coxsackie A
Bact: strep A
Pharyngitis Sx
Sore throat and fever
+ other viral sx (rhinorhea, cough etc)
- tonsil erythema and elnargment
-LAD
Mono etiology and Sx
EBV
Sx:
fever, FATIGUE, sore throat
-Tender cervical lymphadenopathy and palpable splenomegaly
Mono dx
Heterophile antibody test
-monospot rapid serological test
CBC with differential
* activity restriction for 4 weeks to prevent spleen rupture
Bacterial Pharyngitis Etiology common
- Group A strep
GAS pharyngitis
Sx: Abrupt onset, sore throat, odynophagia +/- fever
- exudates
- palatal petechiae
- Tender cervical LAD
Centor Criteria
1 point for each tonsil exudates tender anterior cerival LAD fever by history absence of cough Results >3 perform RADT
GAS DX
Rapid antigen detection test Sx: ABx in first 48hrs -oral penicicillins, amoxicillin -1st gen ceph -Azithromycin for PCn allergy
Acute Rheumatic Fever
2-4 weeks after infection
- Migratory arthritis
- Carditis- may have damage to valves
- CNS involvment
- Subcutaneous nodules
- Erythema marginatum- non prurirtic rash to runk and limbs
Post streptococal glomerulonephritis Sx
Hx of GAS or other throat infection
Sx: asymptomatic microscopic hematuria or full blown acute nephritis
-edema, gross hematuria, hypetension
Glomerulonephritis labs and tx
UA: hematuria +/- RBC casts, proteinuria, pyuria
C3 and CH50 depressed
+ streptozyme test
Tx: Treat volume overload
Who gets their tonsils removed?
7 episodes a year or 5 episodes in each 2 years 3 episodes in 3 years Episode: ST + fever >100.9 tonsilar exudate OR cervical adenopathy recommend 12 month observation period
Oral Candidiasis tx
Nystatin oral suspension
Mumps etiology
Sx
mumps virus
Sx:
fever, HA, Myalgia, Fatigue
within 48hrs Parotitis
Parotits causes and sx
Viral-MUMPS or
Bacterial: suppurative parotitis more common in adults
salivary gland swelling
Tx: Supportive care (acet/ cold or warm packs)
