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Pediatrics 1 > HEENT X3 > Flashcards

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
Q

Otitis externa etiology and sx

A

P.aeruginosa, s. aureus, s. epidermis
Sx: otalgia, pruitis, discharge
-tragus tenderness,
-erythema of the ear canal

26
Q

Otitis externa tx

A 
ABx
- Cortisporin (not with perf TM)
-Floxin 
-Ciprodex
Acidifying solutions -acetic acid 
*use of ear wick PRN
27
Q

Allergic Rhinitis pattern of sx and Severity

A 
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
Q

Allergic Rhinitis Physical Findings

A
  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
Q

Allergic Rhinitis Pham Tx

A
  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
Q

SAMTERs Triad

A

nasal polyps (rare under 10 except CF)
asthma
ASA (asprin) sensitity

31
Q

Nasal poply clinical finding

A
  • obstruction
  • hyponasal speech
  • profuse rhinorrhea (on side of polyp)
32
Q

Nasal Polyp Tx

A

Decongestants
Intranasal steroid sprays
systemic steroids
surgical removal

33
Q

Etiology of viral URI

Sx

A 
50% is rhinovirus 
Sx: non toxic appearance 
- fever in young children
Infants: fever and nasal dicharge 
School age: nasal congestion, discharge, and cough
34
Q

Caution with OTC decongestants

A

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
Q

CLinical presentation of bacterial rhinosinititus

A

Sx: discharge, or congestion, cough, facial pain, HA, fever
- see erythema of nasal turbinates
mucopurulanet discharge + postnasal drip

36
Q

Dx for Acute vs. Chronic Rhinosinusitis

A

Acute: >10<30X-ray or CT
Chronic: (>12wks )
Xray, CT, MR
- maybe culture, Blood work, surgery

37
Q

Tx Acute Sinusitis

A 
Saline irrigation
decongestant- oral/top
antihistamines
intransal glucocorticoids 
*if bacterial> augmenten 
45mg/kg/day
38
Q

Chronic sinusitis Tx

A

saline irrigation
intranasal glucocorticoids
ABx if bacterial
Anti-leukotreine agents

39
Q

Pharyngitis etiology

A

Viral-most common
adenovirus and Coxsackie A
Bact: strep A

40
Q

Pharyngitis Sx

A

Sore throat and fever
+ other viral sx (rhinorhea, cough etc)
- tonsil erythema and elnargment
-LAD

41
Q

Mono etiology and Sx

A

EBV
Sx:
fever, FATIGUE, sore throat
-Tender cervical lymphadenopathy and palpable splenomegaly

42
Q

Mono dx

A

Heterophile antibody test
-monospot rapid serological test
CBC with differential
* activity restriction for 4 weeks to prevent spleen rupture

43
Q

Bacterial Pharyngitis Etiology common

A
  1. Group A strep
44
Q

GAS pharyngitis

A

Sx: Abrupt onset, sore throat, odynophagia +/- fever

  • exudates
  • palatal petechiae
  • Tender cervical LAD
45
Q

Centor Criteria

A 
1 point for each 
tonsil exudates 
tender anterior cerival LAD
fever by history 
absence of cough 
Results >3  perform RADT
46
Q

GAS DX

A 
Rapid antigen detection test 
Sx: ABx in first 48hrs 
-oral penicicillins, amoxicillin
-1st gen ceph
-Azithromycin for PCn allergy
47
Q

Acute Rheumatic Fever

A

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
Q

Post streptococal glomerulonephritis Sx

A

Hx of GAS or other throat infection
Sx: asymptomatic microscopic hematuria or full blown acute nephritis
-edema, gross hematuria, hypetension

49
Q

Glomerulonephritis labs and tx

A

UA: hematuria +/- RBC casts, proteinuria, pyuria
C3 and CH50 depressed
+ streptozyme test
Tx: Treat volume overload

50
Q

Who gets their tonsils removed?

A 
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
Q

Oral Candidiasis tx

A

Nystatin oral suspension

52
Q

Mumps etiology

Sx

A

mumps virus
Sx:
fever, HA, Myalgia, Fatigue
within 48hrs Parotitis

53
Q

Parotits causes and sx

A

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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