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Old Peds > Lecture 10/15 > Flashcards

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

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2
Q

What are three causes of blepharitis?

A

meibomian gland dysfunction
Staphylococcus infection
Seborrhea (seen in people w/ long eyelashes)

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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.

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4
Q

What is the most common source of blepharitis?

A

Staphylococcus infection

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5
Q

What is the main cause of a hordeolum?

A

Staph infection

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6
Q

What glands are infected in an external hordeolum?

A

glands of Zeis in lid

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7
Q

What gland are infection with an internal style (can lead to a chalazion)?

A

meibormian glands

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8
Q

How do you treat a hordeolum?

A

Warm compresses
Local antibiotics to prevent recurrence/ secondary infection
Drainage
Often self limiting

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9
Q

Is a hordeolum painful?

A

Yes- usually red and painful

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10
Q

what type antibiotics do you use for eye problems?

A

Topical antibiotic (oral antibiotics don’t accumulate in conjuntiva as well)

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11
Q

Obstruction / Inflammation in a Meibomian glad. It may develop acute suppuration infection. A lump is seen over the tarsal plate

A

Chalazion

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12
Q

Therapy for chalazion?

A

Warm compresses
Antibiotics to reduce cellulitis
chronic cysts may need incision and curette

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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

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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

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15
Q

What organisms will cause infection with a nasolacrimal duct osbstruction?

A

Strep and Staph

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16
Q

Tx for nasolacrimal duct obstruction if it persists past 1st year of life.

A

Open the ducts surgically via probing

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17
Q

when do most nasolacrimal duct obstructions clear by

A

1st year of life

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18
Q

How do you treat nasolacrimal duct obstruction?

A

massage over lacrimal sac

local antibiotics drops for secondary infection

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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

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20
Q

How do you treat viral conjunctivitis?

A

Supportive- eye drops, antihistamiens

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21
Q

Most common cause of viral conjunctivitis?

A

Adenovirus

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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

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23
Q

most common causes of bacterial conjunctivitis. (from most to least common)

A

Staph aureus (skin infection)
Strep pneumo
H. flu

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24
Q

Tx for bacterial conjunctivitis.

A

Topical erythromicin
polymixin-bacitracin
sulfacetamide
fluoroquinolones

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25
Q

Why are you not as concerned for choosing a specific type of antibiotic for bacterial conjunctivitis?

A

Since it is right on the eye it will usually kill it not matter what

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26
Q

What is the name for neonatal conjunctivitis?

A

Opthalmia Neonatorum

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27
Q

What is the big concern with ophthalmia neonatorum?

A

Gonorrhea or chlamydia from birth canal

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28
Q

how do you treat ophthalmia neonatorum?

A

systemic antibiotic tx (Erythromycin)

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29
Q

For conjunctivitis are labs common?

A

No, except for chlamydia (want direct culture)

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30
Q

Presents with itchy eye, rubbing of eyes, watery discharge and no injection. Often have lid edema, nasal congestion, sneezing.

A

Allergic conjuntivitis

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31
Q

Allergic conjunctivitis often presents with ______________ on tarsal conjunctiva.

A

cobblestone papillae

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32
Q

What indicates corneal involvement and possible serious loss of vision with allergic conjunctivitis.

A

Photophobia or reduced vision (suggest vernal conjunctivitis)

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33
Q

How do you diagnose vernal conjunctivitis (chronic form of allergic conjunctivitis)?

A

Eosinophils in conjunctival scraping

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34
Q

How do you treat allergic conjunctivitis?

A 
Topical solutions (antihistamines) - usually older than 6
combing antihistamine and mast cell stabilizers
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35
Q

Inflammation of the cornea- not common with conjunctivitis

A

Keratitis

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36
Q

Causes of keratitis

A

HSV
N. gonorrhea
adenovirus

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37
Q

Treatment for HSV keratitis?

A

Ocular acyclovir and ophthalmology referral

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38
Q

complications of keartitis?

A

Corenal scarring

iritis and deep keratitis

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39
Q

Do you want to put steroids in the eye?

A

Never because they cause rapid progression and can lead to corneal perf

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40
Q

Physical scratch over cornea

Usually d/t trauma or FB

A

Corenal abrasion

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41
Q

Tx for corneal abrasion

A

Antibiotics to avoid secondary infections (common)

patching for comfort if symptoms severe

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42
Q

Presents with pain, blurred vision and photophobia.

A

Corneal abrasion

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43
Q

What do you use to revel a corneal abrasion.

A

Fluorescein exam

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44
Q

What is similar to a corneal abrasion but often related to rheumatologic dz (RA, sjorgen, SLE (lupus), polyarteritis nodosa)

A

Corneal Ulcer

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45
Q

How do you treat corneal ulcers?

A

Tx underlying dz, usually by rheumatology

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46
Q

How long are antibiotics for eye infections usually?

A

5-7 days

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47
Q

Blood in anterior chamber. Usually due to trauma, glaucoma, vascular abnormalities.

A

Hyphema

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48
Q

How do you treat hyphema?

A

Treat underlying dz is applicable, pain management
referral to ophthalmology
may need surgical correction

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49
Q

Presents with dilated pupil, hazy white color, possibly white reflex. Can be painful. Will have tunnel vision

A

Glaucoma

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50
Q

Tx for glaucoma

A

Refer to ophthalmology

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51
Q

Opacity of the lens. Unilateral or bilateral.

A

Cataract

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52
Q

infective causes for cataract

A

CMV
Varicella
Rubella
(congenital)

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53
Q

Symptoms of a cataract

A

Leukocoria, strabismus, nystagmus, poor fixation

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54
Q

How do you diagnose a cataract?

A

altered red reflex on opthalmoscopic

workup for infection, metabolic, chormosome

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55
Q

How do you manage catarcts?

A

Surgery

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56
Q

decrease in the child’s vision that can happen even when there is no problem with the structure of the eye.

A

Amblyopia

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57
Q

how do you treat amblyopia?

A

Patching the good eye to train the bad eye

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58
Q

What are types of amyblyopia

A

Strabismic amblyopia,
deprivation amblyopia
refractive amblyopia

59
Q

Most strabismus is the result of an abnormality of the poorly understood _________ (including brain) control of eye movement

A

neuromuscular

60
Q

what is hypotropia

A

eye is rotated down

61
Q

what is hypertropia

A

eye is rotated up

62
Q

what nerve palsys can cause strabismus?

A 
3rd cranial nerve
superior oblique (4th CN- trochlear)
63
Q

What disorders are more likely to cause strabismus?

A

cerebral palsy
down syndrome
hydrocephalus
brain tumor

64
Q

Oscillatory movement of eyes, may be horizontal, vertical or torsional/rotational

A

Nystagmus

65
Q

Potential treatments for strabismus

A

eye glasses
eye exercises
prism
eye muscle surgery.

66
Q

What are some congenital causes of nystagmus?

A

neurologic dysfunction
decreased visual acuity
idiopathic
rarely glioma

67
Q

Acquired causes of nystagmus

A

Vestibular lesions/inflammation/infection
brain lesions/ malformations
muscle spasms
medications

68
Q

Neovascularization of immature vasculature seen in preemies (< 1500g)

A

Retinopathy of Prematurity (ROP)

69
Q

What can induce ROP?

A

excess O2 supplementation
hypoxemia
illness

70
Q

What does ROP result in?

A

Retinal detachment and vision loss

71
Q

How do you treat ROP?

A

medical or surgical ablation vessels by optho

72
Q

Inflammation of skin lining in the ear canal

A

Otitis externa

73
Q

Risk factors for otitis externa

A

Water trapper “swimmers ear”

Trauma to canal from q tip

74
Q

main pathogens for otitis externa

A 
Pseudomonas aeurginosa (most common) 
staph aureus
75
Q

symptoms of otitis externa?

A

Pain and itching, +/- purulent discharge,

pain elicited with traction on pinna or tragus

76
Q

Treatment for otitis externa

A

Topical –2% acetic acid to restore ph …. Or antibiotic / corticosteroid drops . Cipro HC (flouroquinolones)

77
Q

what should you never use in the ear?

A

Aminoglycosides

78
Q 
Grey/ translucent TM
Air fluid levels
Bubbles
Little to no movement of TM
TM may be retracted
A

Otitis media with effusion

79
Q

What are some symptoms of otitis medial with effusion?

A

Hearing loss
fullness or ear
may have vertigo

80
Q

What are some contributing factors for otitis media with effusion?

A

allergic rhinitis
tonsilar/ adenoid hypertrophy
sinusitis
eustachian dysfunction

81
Q

What is the effusion like with otitis media with effusion?

A

Mucoid or serous but not puss

82
Q

Tx for OME

A

watchful waiting

put tubes in ear

83
Q

Results from post nasal drainage, URI/allergies

inflammation leads to poor regulation in middle early. because the tube i horizontal

A

Eustachian dysfunction

84
Q

Symptoms of eustachian dysfunction.

A

Ear pain/ fullness/ popping sensation

decreased hearing

85
Q

What is one cause of ear infection in infants?

A

Drinking bottle on back

86
Q

When does acute otitis media peak?

A

6-24 months

87
Q

what is recurrent OM?

A

> 4 episodes in 6 months or failed tx twice

88
Q

Symptoms of acute otitis media?

A 
poor reeding
fever
pain/ irritability
pulling on ear
vomiting
89
Q

what is the highest predictive value of acute otitis media.

A

bulging tympanic membrane

90
Q

What is the triad of AOM?

A

recent onset of illness (URI common)
signs/ symptoms of middle ear inflammation
otoscopic findings (evidence of effusion)

91
Q

Predisposing factors of AOM?

A 
Nasopharygneal colonization
cigarette smoke
unfavorable eustachian tubes
allergies
under-immunization
anatomic abnormalities
92
Q

What organisms cause of AOM?

A

S. pneumo (biggest one)
H. influenza
Moraxella catarrhalis

93
Q

What are some viral causes of AOM?

A

RSV

influenza

94
Q

If a kids is <2 years old and has AOM when do you treat them?

A

with a fever

95
Q

If a child is <6 months old how do you treat AOM?

A

antibiotics

96
Q

when do you not treat with antibiotics for AOM?

A

not febrile
supportive therapy helps enough
no ruptured ear drum
only one ear

97
Q

What is the first line treatment for AOM?

A

amoxicillin 90 mg/kg/day for 10 days

98
Q

If a child is allergic to amoxicillin what do you treat for AOM?

A 
cefdinir
cefpodoxime
cefuroxime
azithromycin
clarithromycin
99
Q

What is the second line tx for AOM? (also first line for those with severe illness- moderate to severe otalgia or fever, both ears)

A

amoxicillin-clavulanate 90 mg/kg/day

ceftriaxone (50 mg/kg) parenterally for 1-3 days (usually for recurrent or failed 2nd line)

100
Q

how can you reduce risk of AOM?

A

breastfeeding for at least first 6 months
avoid supine bottle feeding
eliminate pacifier use after 6 months
eliminate tobacco smoke

101
Q

what gets the higher dose of amoxicillin?

A

ear infections (less blow flow)

102
Q

what children are at more risk for AOM?

A

boy, LBW, premature
childcare
cleft palate

103
Q

When are PE tubes indicated?

A

Chronic OME with conductive hearing loss

failed tx for AOM

104
Q

Do PE tubes prevent ear infections?

A

No, allows drainage of fluid that comes with ear infections. Prevents progression of those infections to hearing loss

105
Q

when do TE tubes usually fall out?

A

6 months- 2 years

106
Q

What does scar tissue from TM perf cause?

A

Hearing loss

107
Q

With a TM perf that is almost complete what happens?

A

only have bone conduction, not air conduction

can lead to hearing loss

108
Q

What are some complications of OME/AOM

A

tympanosclerosis= white palques on TM scars
Perf
Mastoiditis

109
Q

is there any evidence to support prophylactic ABX of OME?

A

no (some for recurrent AOM)

110
Q

Complication of masoiditis

A

Brain abscess

Surgical emergency!

111
Q

what causes mastoiditis?

A

complication of AOM

112
Q

what are the most common bacteria that cause mastoiditis?

A

Strep penumoniae

Strep pyogenes

113
Q

symptoms of mastoiditis

A

postauricular pain, fever, displacement of pinna.

114
Q

what is a complication of mastoiditis

A

meningitis

brain abscess

115
Q

How do you treat mastoiditis?

A

Myringotomy to obtain culture
hospitalize with IV ABX
corticalmastoidectomy if severe

116
Q

Growing mass of epithelial tissue within middle ear and temporal bone.

A

Cholesteatoma

117
Q

Complications of cholesteatoma

A

Damaging hear anatomy
pemanent hearing loss
invasion into bone and brain (abscess)

118
Q

How do you get a cholesteatoma?

A

congenital

acquired (chronic AOM, perf ear drum)

119
Q

what is the main thing you’ll see first with cholesteatoma?

A

hearing loss

120
Q

How do you treat cholesteatoma?

A

Surgical removal

121
Q

what is the most common cause of conductive hearing loss in children?

A

OM

122
Q

What is sensorineural hearing loss due to?

A

due to defect in cochlear receptor cells or auditory nerve (CN VIII)

123
Q

What are some risk factors for sensorineural hearing loss (SNHL)?

A

LBW 50 days)

124
Q

What are acquired reasons for SNHL?

A

ototoxic med- gentamicin
infection- meningitis, syph, lyme dz, CMV
autoimmune or neoplastic conditions

125
Q

How do you test hearing at birth to 4 months?

A

startle to sounds

BAER or ABR

126
Q

How do you test hearing at 4 month to 2 years?

A

using soft soundmaker outside child’s field of vision

127
Q

what do you do for natal teeth?

A

Dental eval, possible extraction

often no roots and have an aspiration risk

128
Q

What is considered late tooth development?

A

no teeth by age 15 months or single tooth eruption missing mirror pair

129
Q

10+ small mouth ulcers on buccal mucosa, anterior pillars, inner lips, tongue, gingiva (not posterior pharynx)

A

Herpes Simplex Virus (HSV)

130
Q

What are symptoms of HSV?

A

Fever

cervical adenopathy

131
Q

How long does a flare of HSV occur for?

A

7-10 days

132
Q

Most common cause of dental caries.

A

Strep viridans

133
Q

what age are children more at risk for HSV?

A

<3 years old

134
Q

Tx for HSV.

A

Acyclovir

135
Q

What can HSV cause, especially in newoborns

A

Optic neuritis
meningitis
encephalitis

136
Q

Should you give corticosteroids with HSV?

A

No- it will spread the infection

137
Q

White curd-like plaques on the inner checks or tongue that doesn’t scrape off.

A

Thrush/ candida albicans

138
Q

Symptoms for thursh.

A

refusal of feeding

in pain

139
Q

how do you treat thursh?

A

Nystatin

140
Q

Erosions to oral mucosa that has an unknown etiology. Increases with stress, recent illness, irritants (spicy food), vitamin deficiency.

A

Oral aphthae

141
Q

what can oral aphthae be a sign of if recurrent or there are a lot of them?

A

Systemic illness (HIV, celiac, IBD, SLE, etc)

142
Q

Treatment for oral aphthae

A

Dietary avoidance, mucosal protectants, pain mgmt

143
Q

Where is the cone of light on the ear?

A

Always angled toward the front of their face

144
Q

What is a good guideline for failed treatment for AOM?

A

If they have another ear infection within 12 months

Old Peds (15 decks)

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