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HEENT X3 Flashcards

1
Q

Bacterial COnjunctivits Tx

A

Ointment preferred
Erythromycin ointment
Trimetoprim-polymyxin B drops
*oint may have blurry vision for 20min

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2
Q

Neonatal conjunctivitis
etiology
sx/dx

A

chlamydia trachomatis
Sx: watery>mucopurulent>bloody
chemosis and pseudomembrane
Dx: NAAT

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3
Q

Neonatal Conjunctivits Tx

A

Oral erythromycin 50mg/Kg QID for 14days

*cannot use topical!!!

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4
Q

hyperacute bacterial conjunctivits
etiology
presentation

A 
Neisseria gonorrhoeae
Sx: 2-5 days after birth
profuse purulent discharge 
chemosis 
\+/- urethritis
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5
Q

hyperacute bacterial conjunctivitis Tx

A

Immidiate hospitalization

and opthamologic referall

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6
Q

What are contact lens wearers at risk for?

A 
Pseudomonal keratitis 
sx of keratitis 
- foreign body sensation
-blepharospasm 
-visual opacity with penlight 
*immediate optha referall (12-24)
Tx: discontinue lens use 
-antipseudo abx
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7
Q

Viral Conjunctivitis Tx

A

topical antihistamines
-naphcon A
Lubricant eye drops

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8
Q

When can children return to school and sports after conjunctivitis

A

-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

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9
Q

Pharm managment of allergic conjunctivitis

A
  1. Antihistamine with mast cell stabilizing properties >3yo
    olopatadine, azelastine
  2. OTC topical vasoconstrictor and antihistamine <2wk
    -naphcon A Visine A
  3. Mast cell stabilizer >4yo
    cromolyn opthalmic
    - only an opthamologist will prescribe topical glucocorticoids
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10
Q

Kawasaki presentation

A 
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
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11
Q

Kawasaki Disease complications

A 
Cadiovascular complications 
- cornonary aneurysms and carditis 
Manifestations
- tachycardia (greater than you would expect with fever)
-gallop
-muffled heart tones 
Dx echocardiogram
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12
Q

What suggests increased risk of cardiac aneurisms c Kawasaki? What will the labs show?

A 
<1  >6
fever >14
serum sodium <135 mEq/L
Heatocrit <35%
WBC >12000/mm3
Labs 
^ESR, thrombocytosis, leukocytosis  (Immature neutrophils), normocytic, normochromic anemia, hyponatremia
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13
Q

Tx of Kawasaki

A

IVIG
High dose asprin
delay vaccines

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14
Q

Strbisumus dx and managment

A

Dx: abnormal corneal light reflection

conver uncover test will demonstrate deviation

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15
Q

dacrostenosis presentation

A

Nasolactrimal duct obstruction
-b/c persistant tearing and ocular discharge
Sx: chronic tearing, mucoid discharge, debris on lashes, mild redness of lower lid

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16
Q

dx and tx of dacrostenosis

A
  • most resolve spontaniously
    1. Lacrimal sac massage
  • surgical probe would be definitive
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17
Q

dacryocystitis etiology and presentation

A

inflamation of lacrimal sac
etiology: staphylococcus
Sx: erythema, swelling, warmth, tenderness of larimal sac, purulent discharge

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18
Q

Tx of dacryocystitis

A

oral clindamycin (mild)
or
IV vanco and 3rd gen ceph

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19
Q

Most common etiology for acute otitis media

A

S. Pneumonia
H. influenza
Moraxella catarrhalis

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20
Q

Acute Otitis Media Sx

A

Sx: otalgia, fever, irritability
PE: Bulding TM with decreased motility
otorrhea erythematous TM

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21
Q

Acute Otitis Media Tx

A
  1. Analgesics (ibu/acet)
  2. high dose amoxicillin 90mg/kg/12hrs
    -if no recent B lactam, purulent discharge or rec sx
    10day <2 5-7 >2yrs
  3. Augmentent -if the above were met
    if PCN allergery cefdinir, azithromycin, clindamycin
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22
Q

Acute otitis Media who gets abx

A 
<6mo 
severe sx: ^pain, >48hrs, >102.2
Bilateral >2yrs 
-potentially unilateral <2yrs 
follow up in 48 hrs
23
Q

Recurrent AOM prophylaxis

A 
>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
24
Q

Clinical pres of otitis media with effusion

A

Retracted TM

decreased motility of TM

25
Otitis externa etiology and sx
P.aeruginosa, s. aureus, s. epidermis Sx: otalgia, pruitis, discharge -tragus tenderness, -erythema of the ear canal
26
Otitis externa tx
``` ABx - Cortisporin (not with perf TM) -Floxin -Ciprodex Acidifying solutions -acetic acid *use of ear wick PRN ```
27
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 ```
28
Allergic Rhinitis Physical Findings
1. Allergic Shiners 2. allergic cnjunctivitis - dennie morgan lines 3. Allergic salute- crease on nose 4. Pale blue boggy nasal mucosa 5. Edematous turbinates 6. Post Pharynx- cobblestoning
29
Allergic Rhinitis Pham Tx
1. Steroids (first line) -fluticasone (flonase) 2. Antihistamines first gen: diphenhydrmine sec gen: cetirizine, loratidine intranasal: azelastine, olopatadine 3. Decongestants 4. Anticholinergics -ipratropium 5. Mast Cell Stabilizer cromolyn 6. LTR antagonist -motelukast
30
SAMTERs Triad
nasal polyps (rare under 10 except CF) asthma ASA (asprin) sensitity
31
Nasal poply clinical finding
- obstruction - hyponasal speech - profuse rhinorrhea (on side of polyp)
32
Nasal Polyp Tx
Decongestants Intranasal steroid sprays systemic steroids surgical removal
33
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 ```
34
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
35
CLinical presentation of bacterial rhinosinititus
Sx: discharge, or congestion, cough, facial pain, HA, fever - see erythema of nasal turbinates mucopurulanet discharge + postnasal drip
36
Dx for Acute vs. Chronic Rhinosinusitis
Acute: >10<30X-ray or CT Chronic: (>12wks ) Xray, CT, MR - maybe culture, Blood work, surgery
37
Tx Acute Sinusitis
``` Saline irrigation decongestant- oral/top antihistamines intransal glucocorticoids *if bacterial> augmenten 45mg/kg/day ```
38
Chronic sinusitis Tx
saline irrigation intranasal glucocorticoids ABx if bacterial Anti-leukotreine agents
39
Pharyngitis etiology
Viral-most common adenovirus and Coxsackie A Bact: strep A
40
Pharyngitis Sx
Sore throat and fever + other viral sx (rhinorhea, cough etc) - tonsil erythema and elnargment -LAD
41
Mono etiology and Sx
EBV Sx: fever, FATIGUE, sore throat -Tender cervical lymphadenopathy and palpable splenomegaly
42
Mono dx
Heterophile antibody test -monospot rapid serological test CBC with differential * activity restriction for 4 weeks to prevent spleen rupture
43
Bacterial Pharyngitis Etiology common
1. Group A strep
44
GAS pharyngitis
Sx: Abrupt onset, sore throat, odynophagia +/- fever - exudates - palatal petechiae - Tender cervical LAD
45
Centor Criteria
``` 1 point for each tonsil exudates tender anterior cerival LAD fever by history absence of cough Results >3 perform RADT ```
46
GAS DX
``` Rapid antigen detection test Sx: ABx in first 48hrs -oral penicicillins, amoxicillin -1st gen ceph -Azithromycin for PCn allergy ```
47
Acute Rheumatic Fever
2-4 weeks after infection 1. Migratory arthritis 2. Carditis- may have damage to valves 3. CNS involvment 4. Subcutaneous nodules 5. Erythema marginatum- non prurirtic rash to runk and limbs
48
Post streptococal glomerulonephritis Sx
Hx of GAS or other throat infection Sx: asymptomatic microscopic hematuria or full blown acute nephritis -edema, gross hematuria, hypetension
49
Glomerulonephritis labs and tx
UA: hematuria +/- RBC casts, proteinuria, pyuria C3 and CH50 depressed + streptozyme test Tx: Treat volume overload
50
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 ```
51
Oral Candidiasis tx
Nystatin oral suspension
52
Mumps etiology | Sx
mumps virus Sx: fever, HA, Myalgia, Fatigue within 48hrs Parotitis
53
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)

Pediatrics 1 (6 decks)

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