Lecture 10/15 Flashcards
1
Q
inflammation of the lid margins may be associated with conjunctivitis. Presents with burning, irritation, photophobia. Looks greasy and oily around eyelid/ lashes.
A
Blepharitis
2
Q
What are three causes of blepharitis?
A
meibomian gland dysfunction
Staphylococcus infection
Seborrhea (seen in people w/ long eyelashes)
3
Q
How do you treat blepharitis?
A
Local steroid and antibiotic ointment applied at night (depending on cause). This may be needed long term as the condition tends to recur.
4
Q
What is the most common source of blepharitis?
A
Staphylococcus infection
5
Q
What is the main cause of a hordeolum?
A
Staph infection
6
Q
What glands are infected in an external hordeolum?
A
glands of Zeis in lid
7
Q
What gland are infection with an internal style (can lead to a chalazion)?
A
meibormian glands
8
Q
How do you treat a hordeolum?
A
Warm compresses
Local antibiotics to prevent recurrence/ secondary infection
Drainage
Often self limiting
9
Q
Is a hordeolum painful?
A
Yes- usually red and painful
10
Q
what type antibiotics do you use for eye problems?
A
Topical antibiotic (oral antibiotics don’t accumulate in conjuntiva as well)
11
Q
Obstruction / Inflammation in a Meibomian glad. It may develop acute suppuration infection. A lump is seen over the tarsal plate
A
Chalazion
12
Q
Therapy for chalazion?
A
Warm compresses
Antibiotics to reduce cellulitis
chronic cysts may need incision and curette
13
Q
Tear overflow and secondary infection may result from this obstruction resulting from lack of closure of the nasolacrimal ducts.
A
Nasolacrimal Duct obstruction
14
Q
Clinical findings with nasolacrimal duct obstruction.
A
watery, discharging eyes in first few months of life- can be mucoid
+/- conjunctival redness
Erythema of lids
15
Q
What organisms will cause infection with a nasolacrimal duct osbstruction?
A
Strep and Staph
16
Q
Tx for nasolacrimal duct obstruction if it persists past 1st year of life.
A
Open the ducts surgically via probing
17
Q
when do most nasolacrimal duct obstructions clear by
A
1st year of life
18
Q
How do you treat nasolacrimal duct obstruction?
A
massage over lacrimal sac
local antibiotics drops for secondary infection
19
Q
Watery discharge Tender preauricular lymph node Can present with pharyngitis, cold sxs injected eyes, usually unilateral initially and spreads to other eye 1-3 days later Dry or burning sensation/ itching
A
Conjunctivitis - Viral
20
Q
How do you treat viral conjunctivitis?
A
Supportive- eye drops, antihistamiens
21
Q
Most common cause of viral conjunctivitis?
A
Adenovirus
22
Q
Red eyes, sore but not painful
In just one eye or both together at same time
Muco-purulent discharge
Usually really itching/ sore but not painful
usually not with cold symptoms
A
conjunctivitis- bacterial
23
Q
most common causes of bacterial conjunctivitis. (from most to least common)
A
Staph aureus (skin infection)
Strep pneumo
H. flu
24
Q
Tx for bacterial conjunctivitis.
A
Topical erythromicin
polymixin-bacitracin
sulfacetamide
fluoroquinolones
25
Why are you not as concerned for choosing a specific type of antibiotic for bacterial conjunctivitis?
Since it is right on the eye it will usually kill it not matter what
26
What is the name for neonatal conjunctivitis?
Opthalmia Neonatorum
27
What is the big concern with ophthalmia neonatorum?
Gonorrhea or chlamydia from birth canal
28
how do you treat ophthalmia neonatorum?
systemic antibiotic tx (Erythromycin)
29
For conjunctivitis are labs common?
No, except for chlamydia (want direct culture)
30
Presents with itchy eye, rubbing of eyes, watery discharge and no injection. Often have lid edema, nasal congestion, sneezing.
Allergic conjuntivitis
31
Allergic conjunctivitis often presents with ______________ on tarsal conjunctiva.
cobblestone papillae
32
What indicates corneal involvement and possible serious loss of vision with allergic conjunctivitis.
Photophobia or reduced vision (suggest vernal conjunctivitis)
33
How do you diagnose vernal conjunctivitis (chronic form of allergic conjunctivitis)?
Eosinophils in conjunctival scraping
34
How do you treat allergic conjunctivitis?
```
Topical solutions (antihistamines) - usually older than 6
combing antihistamine and mast cell stabilizers
```
35
Inflammation of the cornea- not common with conjunctivitis
Keratitis
36
Causes of keratitis
HSV
N. gonorrhea
adenovirus
37
Treatment for HSV keratitis?
Ocular acyclovir and ophthalmology referral
38
complications of keartitis?
Corenal scarring
| iritis and deep keratitis
39
Do you want to put steroids in the eye?
Never because they cause rapid progression and can lead to corneal perf
40
Physical scratch over cornea
| Usually d/t trauma or FB
Corenal abrasion
41
Tx for corneal abrasion
Antibiotics to avoid secondary infections (common)
| patching for comfort if symptoms severe
42
Presents with pain, blurred vision and photophobia.
Corneal abrasion
43
What do you use to revel a corneal abrasion.
Fluorescein exam
44
What is similar to a corneal abrasion but often related to rheumatologic dz (RA, sjorgen, SLE (lupus), polyarteritis nodosa)
Corneal Ulcer
45
How do you treat corneal ulcers?
Tx underlying dz, usually by rheumatology
46
How long are antibiotics for eye infections usually?
5-7 days
47
Blood in anterior chamber. Usually due to trauma, glaucoma, vascular abnormalities.
Hyphema
48
How do you treat hyphema?
Treat underlying dz is applicable, pain management
referral to ophthalmology
may need surgical correction
49
Presents with dilated pupil, hazy white color, possibly white reflex. Can be painful. Will have tunnel vision
Glaucoma
50
Tx for glaucoma
Refer to ophthalmology
51
Opacity of the lens. Unilateral or bilateral.
Cataract
52
infective causes for cataract
CMV
Varicella
Rubella
(congenital)
53
Symptoms of a cataract
Leukocoria, strabismus, nystagmus, poor fixation
54
How do you diagnose a cataract?
altered red reflex on opthalmoscopic
| workup for infection, metabolic, chormosome
55
How do you manage catarcts?
Surgery
56
decrease in the child’s vision that can happen even when there is no problem with the structure of the eye.
Amblyopia
57
how do you treat amblyopia?
Patching the good eye to train the bad eye
58
What are types of amyblyopia
Strabismic amblyopia,
deprivation amblyopia
refractive amblyopia
59
Most strabismus is the result of an abnormality of the poorly understood _________ (including brain) control of eye movement
neuromuscular
60
what is hypotropia
eye is rotated down
61
what is hypertropia
eye is rotated up
62
what nerve palsys can cause strabismus?
```
3rd cranial nerve
superior oblique (4th CN- trochlear)
```
63
What disorders are more likely to cause strabismus?
cerebral palsy
down syndrome
hydrocephalus
brain tumor
64
Oscillatory movement of eyes, may be horizontal, vertical or torsional/rotational
Nystagmus
65
Potential treatments for strabismus
eye glasses
eye exercises
prism
eye muscle surgery.
66
What are some congenital causes of nystagmus?
neurologic dysfunction
decreased visual acuity
idiopathic
rarely glioma
67
Acquired causes of nystagmus
Vestibular lesions/inflammation/infection
brain lesions/ malformations
muscle spasms
medications
68
Neovascularization of immature vasculature seen in preemies (< 1500g)
Retinopathy of Prematurity (ROP)
69
What can induce ROP?
excess O2 supplementation
hypoxemia
illness
70
What does ROP result in?
Retinal detachment and vision loss
71
How do you treat ROP?
medical or surgical ablation vessels by optho
72
Inflammation of skin lining in the ear canal
Otitis externa
73
Risk factors for otitis externa
Water trapper "swimmers ear"
| Trauma to canal from q tip
74
main pathogens for otitis externa
```
Pseudomonas aeurginosa (most common)
staph aureus
```
75
symptoms of otitis externa?
Pain and itching, +/- purulent discharge,
| pain elicited with traction on pinna or tragus
76
Treatment for otitis externa
Topical –2% acetic acid to restore ph …. Or antibiotic / corticosteroid drops . Cipro HC (flouroquinolones)
77
what should you never use in the ear?
Aminoglycosides
78
```
Grey/ translucent TM
Air fluid levels
Bubbles
Little to no movement of TM
TM may be retracted
```
Otitis media with effusion
79
What are some symptoms of otitis medial with effusion?
Hearing loss
fullness or ear
may have vertigo
80
What are some contributing factors for otitis media with effusion?
allergic rhinitis
tonsilar/ adenoid hypertrophy
sinusitis
eustachian dysfunction
81
What is the effusion like with otitis media with effusion?
Mucoid or serous but not puss
82
Tx for OME
watchful waiting
| put tubes in ear
83
Results from post nasal drainage, URI/allergies
| inflammation leads to poor regulation in middle early. because the tube i horizontal
Eustachian dysfunction
84
Symptoms of eustachian dysfunction.
Ear pain/ fullness/ popping sensation
| decreased hearing
85
What is one cause of ear infection in infants?
Drinking bottle on back
86
When does acute otitis media peak?
6-24 months
87
what is recurrent OM?
>4 episodes in 6 months or failed tx twice
88
Symptoms of acute otitis media?
```
poor reeding
fever
pain/ irritability
pulling on ear
vomiting
```
89
what is the highest predictive value of acute otitis media.
bulging tympanic membrane
90
What is the triad of AOM?
recent onset of illness (URI common)
signs/ symptoms of middle ear inflammation
otoscopic findings (evidence of effusion)
91
Predisposing factors of AOM?
```
Nasopharygneal colonization
cigarette smoke
unfavorable eustachian tubes
allergies
under-immunization
anatomic abnormalities
```
92
What organisms cause of AOM?
S. pneumo (biggest one)
H. influenza
Moraxella catarrhalis
93
What are some viral causes of AOM?
RSV
| influenza
94
If a kids is <2 years old and has AOM when do you treat them?
with a fever
95
If a child is <6 months old how do you treat AOM?
antibiotics
96
when do you not treat with antibiotics for AOM?
not febrile
supportive therapy helps enough
no ruptured ear drum
only one ear
97
What is the first line treatment for AOM?
amoxicillin 90 mg/kg/day for 10 days
98
If a child is allergic to amoxicillin what do you treat for AOM?
```
cefdinir
cefpodoxime
cefuroxime
azithromycin
clarithromycin
```
99
What is the second line tx for AOM? (also first line for those with severe illness- moderate to severe otalgia or fever, both ears)
amoxicillin-clavulanate 90 mg/kg/day
| ceftriaxone (50 mg/kg) parenterally for 1-3 days (usually for recurrent or failed 2nd line)
100
how can you reduce risk of AOM?
breastfeeding for at least first 6 months
avoid supine bottle feeding
eliminate pacifier use after 6 months
eliminate tobacco smoke
101
what gets the higher dose of amoxicillin?
ear infections (less blow flow)
102
what children are at more risk for AOM?
boy, LBW, premature
childcare
cleft palate
103
When are PE tubes indicated?
Chronic OME with conductive hearing loss
| failed tx for AOM
104
Do PE tubes prevent ear infections?
No, allows drainage of fluid that comes with ear infections. Prevents progression of those infections to hearing loss
105
when do TE tubes usually fall out?
6 months- 2 years
106
What does scar tissue from TM perf cause?
Hearing loss
107
With a TM perf that is almost complete what happens?
only have bone conduction, not air conduction
| can lead to hearing loss
108
What are some complications of OME/AOM
tympanosclerosis= white palques on TM scars
Perf
Mastoiditis
109
is there any evidence to support prophylactic ABX of OME?
no (some for recurrent AOM)
110
Complication of masoiditis
Brain abscess
| Surgical emergency!
111
what causes mastoiditis?
complication of AOM
112
what are the most common bacteria that cause mastoiditis?
Strep penumoniae
| Strep pyogenes
113
symptoms of mastoiditis
postauricular pain, fever, displacement of pinna.
114
what is a complication of mastoiditis
meningitis
| brain abscess
115
How do you treat mastoiditis?
Myringotomy to obtain culture
hospitalize with IV ABX
corticalmastoidectomy if severe
116
Growing mass of epithelial tissue within middle ear and temporal bone.
Cholesteatoma
117
Complications of cholesteatoma
Damaging hear anatomy
pemanent hearing loss
invasion into bone and brain (abscess)
118
How do you get a cholesteatoma?
congenital
| acquired (chronic AOM, perf ear drum)
119
what is the main thing you'll see first with cholesteatoma?
hearing loss
120
How do you treat cholesteatoma?
Surgical removal
121
what is the most common cause of conductive hearing loss in children?
OM
122
What is sensorineural hearing loss due to?
due to defect in cochlear receptor cells or auditory nerve (CN VIII)
123
What are some risk factors for sensorineural hearing loss (SNHL)?
LBW 50 days)
124
What are acquired reasons for SNHL?
ototoxic med- gentamicin
infection- meningitis, syph, lyme dz, CMV
autoimmune or neoplastic conditions
125
How do you test hearing at birth to 4 months?
startle to sounds
| BAER or ABR
126
How do you test hearing at 4 month to 2 years?
using soft soundmaker outside child's field of vision
127
what do you do for natal teeth?
Dental eval, possible extraction
| often no roots and have an aspiration risk
128
What is considered late tooth development?
no teeth by age 15 months or single tooth eruption missing mirror pair
129
10+ small mouth ulcers on buccal mucosa, anterior pillars, inner lips, tongue, gingiva (not posterior pharynx)
Herpes Simplex Virus (HSV)
130
What are symptoms of HSV?
Fever
| cervical adenopathy
131
How long does a flare of HSV occur for?
7-10 days
132
Most common cause of dental caries.
Strep viridans
133
what age are children more at risk for HSV?
<3 years old
134
Tx for HSV.
Acyclovir
135
What can HSV cause, especially in newoborns
Optic neuritis
meningitis
encephalitis
136
Should you give corticosteroids with HSV?
No- it will spread the infection
137
White curd-like plaques on the inner checks or tongue that doesn't scrape off.
Thrush/ candida albicans
138
Symptoms for thursh.
refusal of feeding
| in pain
139
how do you treat thursh?
Nystatin
140
Erosions to oral mucosa that has an unknown etiology. Increases with stress, recent illness, irritants (spicy food), vitamin deficiency.
Oral aphthae
141
what can oral aphthae be a sign of if recurrent or there are a lot of them?
Systemic illness (HIV, celiac, IBD, SLE, etc)
142
Treatment for oral aphthae
Dietary avoidance, mucosal protectants, pain mgmt
143
Where is the cone of light on the ear?
Always angled toward the front of their face
144
What is a good guideline for failed treatment for AOM?
If they have another ear infection within 12 months
