Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Peds Exam 2 > Lecture 5 - EENT > Flashcards

Lecture 5 - EENT Flashcards

1
Q

Strabismus

A

misaligned eyes

“TROPIA” - constant

“PHORIA” - intermittent

ESO - inward (adducted)

EXO - outward (abducted)

HYPO - dowards

HYPER - upward

typically unilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pen light test

A

can help you when strabismus is a little more subtle or its psuedostrabismus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

psuedostrabismus

A

epicanthial fold might be different between left and right eye making it appear to have strabismus

pen light test will show that this is not the case

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does a left esotropia look like?

A

the pts left eye is slightly deviated inward and the light from the pen light test is on the outer edge of the eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cover-uncover test

A

child fixes on object in from of them
cover 1 eye and observe the uncovered eye –if it had to move to focus on the eye then it was not initially aligned on the object –suggests tropia

then remove the cover and check the other eye, if it had to move to refocus then it drifted while covered –suggests phoria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Amylopia

A

loss of visual acuity due to cortical suppression of the vision of an eye

the brain suppresses the vision in the one eye –this could become permanent since the brain is trying to avoid double vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the treatment for strabismus?

A

before visual fixation is well established, infants can have esodeviations
-expect normal alignment by 4 months of age

refer pts >4 moths of age with strabismus to ophthalmology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Ophthalmia neonatorum

A

infection of the eye caused by a variety of different things
red eye + discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Chemical conjunctivitis

A

onset within the 1st 24 hours of life
erythema and water discharge
reaction to topical bactericidal

less common now that we dont use silver nitrate and instead use erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the treatment for chemical conjunctivitis?

A

sys resolve within days without need for treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Neisseria gonorrhoeae - ophthalmia neonatorum

A

onset typically occurs 2 to 5 days of age
swelling of lids and conjunctivae
copious purulent discharge
gram stain

complications
-risk for corneal perforation and scar –can lead to blindness

tx:
-ceftriazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the treatment for neisseria gonorrhoeae?

A

cerftriaxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Chlamidia traachomatis ophthalmic presentation?

A

onset typically occurs 4-19 days of age
mild swelling of lids and conunvtivae
hyperemia
scant purulent discharge

complications –infants with chlamydia may develop pneumonitis

tx: erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the treatment for chlamidia traachomatis ophthalmic?

A

erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Herpes simplex virus - ophthalmic

A

viral conjunctivitis RARE in neonates

typically unilateral
onset within 2-4 weeks
vesicular lid lesions

complications: herpetic corneal disease can threaten vision
tx: systemic acyclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Dacryostenosis

A

nasolacrimal duct obstruction

MC cause of tearing in children
-ip to 20% of normal newborns

chronic or intermittent tearing, debris on eyelashes
conjunctival erythema not common but rubbing may result in lid redness
palpation of lacrimal sac may cause reflux of tears and/or mucoid discharge into eye through the puncta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do pts with dacryostenosis present?

A

chronic or intermittent tearing, debris on eyelashes
conjunctival erythema not common but rubbing may result in lid redness
palpation of lacrimal sac may cause reflux of tears and/or mucoid discharge into eye through the puncta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do you treat dacryostenosis?

A

non-surgical observation
lacrimal sac massage may be helpful
referral to ophthalmology if not resolved by 6 months for possible lacrimal duct probing or surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the complications of dacryostenosis?

A

acute dacrocystitis - infection of nasolacrimal system

can lead to orbital cellulitis, sepsis or meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the risk factors for AOM?

A 
tobacco exposure 
use of pacifier
not breastfeeding 
feeding lying down
daycare attendance 
incomplete immunizations
younger age
mild hereditary risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do you dx AOM?

A

these pts are typically consoled by mom

moderate to sever bulging on TM (most specific finding)
often TM will have a white or pale yellow appearance
impaired mobility of the TM with pneumatic otoscopy or tympanogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is a tympanogram?

A

look like ear thromometers

you get a reading based on the light to give you an idea of what is behind the membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the most common pathogen of AOM?

A

S. pneumoniae

a viral infection (RSV, parainfluenza) is typically the predisposing cause but can also be the presenting cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you treat AOM?

A

anybody under 6 months, regardless of bilateral or otorrhea gets ABX (amoxicllin (1st line), cephalexin)

you can observe pts 6months - 2 years if unilateral without otorrhea and kids >2 years uni/bilateral without otorrhea
(observe means follow up 48-72 hours)
everyone else gets ABX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are considered “severe sxs” for AOM?

A

toxic appearing child
otalgia for >48h
temp >39C in last 48 hours
uncertain access to follow up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When do you use augmentin when treating AOM?

A

if pt has concomitant purulent conjunctivits
children who have been treated with amoxicillin in last 30 days
fail initial ABX treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Allergy testing is only commercially available for ____

A

IgE mediation reactions to PCN and NO other ABX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How do you determine allergy vs side effect?

A

Hx

  • timing of onset
  • character of sxs (GI is probably just SE right?)
  • Duration of sxs
  • have they received the drug again, what happened?

Can perform skin testing for PCN

29
Q

When are tympanostomy tubes recommended?

A

3 or more episodes of AOM within 6 month period
OR
4 episodes within a year with 1 in the last 6 months
OR
Children with AOM before 6 months –warrant a more aggressive approach to management

30
Q

Why might pts with tympanostomy tubes have otorrhea?

A

bacterial infection post op
introduction of contaminated water from ear canal into middle ear

tx: fluoroquinolone drops (ofloxacin and ciprofloxacin dexamethasone) —> these are the only topical antimicrobials FDA approved fro treateing otorrhea with non-intact membrane

31
Q

What antimicrobials are FDA approved to treat otorrhea for pts withOUT intact membranes?

A

ofloxacin and ciprofloxacin dexamethasone

32
Q

OME

A

otitis media with effusion

commonly follows URI 
NOT an infectious process
no pain/fever
typically resolves without intervention <3months 
meds really haven't been shown to help

referral for tympanostomy tubes if no resolution in 3 months

33
Q

When should you consider ENT referral for foreign body in the ear?

A

battery
bug
object is pressed up against the TM
object has been in the canal for >24 hours

34
Q

What do you do to remove a foreign body from the ear canal?

A

irrigation is best unless:

  • there is concern of TM perforation
  • the foreign matter will swell (food, insects)
35
Q

Viral Rhinitis

A

MC pediatric infectious disease
-children <5 typically have 6-12 episodes per year

sxs:
clear or mucoid rhinorrhea
nasal congestion
sneezing
often begin with sore throat 
may develop cough and fever (fever more common in <6 y/o)
36
Q

What are the most common causes of URIs in children?

A 
Rhinoviruses (MC) 
adenovirus 
parainfluenza 
RSV (respiratory syncytial virus) 
influenza
37
Q

What can rhinovirus cause?

A 
"common cold" 
pharyngitis
OM
bronchiolitis 
PNA
act as precipitating factor in asthma
38
Q

What is the treatment for viral rhinitis?

A

supportive

increased fluids, rest, cool mist humidifier
nasal saline spray

OTC cold and cough should NOT be used in children <4 and used with caution in children <6

39
Q

What ages should not use cold and cough OTC medications?

A

NOT be used in children <4 and used with caution in children <6

40
Q

What is the typical course of viral rhinitis?

A

simple URI lasts 7-9 days but can last 15 days

fever typically resolves by day 3
sxs peak on day 3
cough lasts longer than other sxs

41
Q

When is the development of paranasal sinuses complete?

A

20 years of age

42
Q

What sinuses develop when?

A

maxillary - rapidly expand by 4 years

sphenoid - develop in first 2 years of life, pneumatized by 5 years, permanent size by 12 years

frontal - can be seen on xray 6-8 years, don’t complete development until 14-18 years of age

43
Q

How do you dx sinusitis?

A

acute bacterial sinusitis must have:
-sxs present for > 10 days
OR
-sxs worsen with new onset of fever or cough
OR
-be associated with temperatures >39 for more than 3 days

color of nasal discharge does NOT indicate infection

44
Q

When is the earliest presentation of allergic rhinitis?

A

10-12 months of age

45
Q

What age do seasonal allergies typically appear?

A

3-4 years of age

46
Q

What is the presentation of allergic rhinitis?

A

ocular

  • itching, swelling, tearing
  • always bilateral (something else if unilateral)
  • uncommon to have photophobia or pain

nasal

  • itching, sneezing, rhinorrhea, congestion
  • “shiners” are non-specific finding
47
Q

What are complications of allergic rhinitis?

A 
OM
poor asthma control 
poor sleep
sinusitis
missed school
missed work
48
Q

What is the treatment for allergic rhinitis?

A

Antihistamines

  • fast acting, short lasting
  • not very effective for congestion, post-nasal drip (not effective for URIs)
  • first gen –sedating SE (don’t use if you can avoid it)
  • second gen –less sedating, last longer

Intranasal steroid spray:

  • no effective when used intermittently or acutely
  • best medication for congestion, post-nasal drip

Leukotriene Modifiers

  • not very effective for rhinoconjunctivits
  • not indicated as monotherapy or 1st line therapy
  • block part of late phase allergic response, no antihistmaine properties

Immunotherapy

  • indicated for refractory sxs despite optimal medical management/avoidance
  • weekly build up x 6-8 months, then monthly injections x 3-5 years
  • no benefit for at least 6-12 months
49
Q

Which generation antihistamines are ideal for allergic rhinitis in children?

A

2nd generation d/t less sedative SEs

50
Q

What are the pros and cons to immunotherapy for allergic rhinitis?

A

Pros:
effective
only disease modifying treatment
may prevent sensitization to new allergens and progression of AR to asthma

Cons:
painful (multiple shots)
risk of anaphylaxis
inconvenient (30 min monitoring pst shot)
slow onset of action
not all pts benefit
must use correct allergens and concentrations

51
Q

Epistaxis treatment

A

sit forward
pinch nose for 5-10 min
nasal steroid spray, packing
referral to ENT for cautery

52
Q

Types of pharyngitis

A

viral

  • infectious mono
  • hand, food, mouth
  • herpangina

Bacterial

Fungal
-thrush

53
Q

presentation of mono

A

tonsillar exudates
cervical lymphadenopathy (posterior chain)
fever

dx:
>10% atypical lymphocytes on blood smear
positive mono spot
EBV serology with elevated IgM is definitive

tx:
symptomatic
amoxicillin can cause RASH

54
Q

Hand, Foot, Mouth

A

coxsackievirus
ulcerations in posterior pharynx surrounded by a halo

macular, maculopapular or vesicular rash on hands and feet

dx
clinical

tx
symptomatic

55
Q

Strep pharyngitis

A

abrupt onset of sore throat, tender cervical lymphadenopathy, fever, erythematous posterior pharynx
N/V/HA
young children

56
Q

Centor 4 point scale

A

fever
absence of cough
anterior cervical adenopathy
tonsilar exudates

strep pharyngitis presentation

57
Q

How do you dx strep?

A

rapid antigen test or throat culture

58
Q

Group A strep is a self-limited disease, so why do we treat?

A

prevent suppurative complications

reduce communicability

prevent Rheumatic fever

59
Q

Actue rheumatic fever

A

occurs 2-4 weeks after GAS pharyngitis, may consist of:

  • arthritis
  • carditis and valvulitis
  • CNS involvment
  • erythema marginatum
  • subcutaneous nodules
60
Q

Brodsky grady scale

A

tonsillar hypertrophy grading 0-4

4 being the tonsils take up most of the orophrayngeal width

61
Q

Paradise Criteria

A

for tonsillectomy

“sore throat episode”
-temp >38.8, or cervical lymphadenopathy, or tonsillar exudate or positive culture for group a strep

criterion definition:
-min 7 or more episodes of sore throat in the last year
OR
-5 or more episodes in each of the preceding 2 years
OR
-3 or more episodes in each of the preceding 3 years

62
Q

Croup

A

laryngotracheitis

parainfluenza type 1 and 2

Type 1 peaks every other autumn

Type 2 has annual peaks

spread through direct contact, droplets, and fomites

incubation 2-6 days

children 6-36 months MC

rare beyond 6 years

63
Q

How do pts with croup present?

A

onset of sxs is gradual
begins with nasal irritation, congestion, rhinorrhea
characterized by inspiratory stridor, hoarseness and distinctive “barking” cough which develop over 12-24 hours
sxs stem from inflammation of the larynx and subglottic airway

presence of cough and absence of drooling help distinguish from epiglottis

64
Q

What is the treatment for croup?

A

mild croup may be managed with supportive care (fluids, mist therapy)

glucocorticoid
-single dose of dexamthasone shortens sxs

Nebulized racemic epi commonly used in ED

65
Q

Why has the incidence of epiglottitis decreased?

A

H. influenzae vaccine

66
Q

What is the presentation of epiglottitis?

A

most common children 2-6 years
sudden onset high fever, dysphagia, DROOLING and muffled voice, unable to clear secretion
inspiratory retractions, stridor, cyanosis
tripod, “sniffing dog”
“thumbprint” sign on lateral neck xray

definitive dx can be made by direct inspection of “cherry red” and swollen epiglotis

67
Q

What is the treatment for epiglotitis?

A

endotracial intubation –typically done in OR d/t risk of respiratory arrest

blood and throat cultures should be obtained

IV abx (ceftriaxone) 
extubation usually 24-48 hours when direct inspection demonstrates reduction in swelling
68
Q

Tx for AOM?

A

High dose amoxicillin = first line therapy
80-90 mg/kg/day BID

If watchful waiting —must have follow up in 48-72 hours

Peds Exam 2 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions