Ophtho, Dentistry, Otolaryngology Flashcards
what is a strabismus?
misalignment of the visual pathway
strabismus defects always present are called?
tropias
strabismus defects found on provocative testing?
phorias
the majority of strabismus cases occur bet. the ages of?
18 months & 6 yo
what will the developing brain do if it is receiving poor-quality visual information from one side (strabismus, cataract, etc)?
it will suppress the information from the abnormal side
visual sensory deprivation leads to what?
chronic visual loss on the affected side
what do you call a chronic visual loss related to dz of visual pathways?
amblyopia
amblyopia leads to what?
reduction in central visual acuity
accounts for 20-70% of visual loss in adults
40% of children w/ strabismus will develop what?
amblyopia
vision screening is subjectively screened up to what age?
3 months of age
vision screening in infancy
red reflex fixation & tracking (approp. for age) test of pupillary refelx corneal light reflex blink to threat
what do you assess for when checking red reflex?
cataracts & intraglobular tumors
vision screening between 6 months to 3 years of age
fixation & tracking
test of pupillar reflex (if child allows)
corneal light replex
strabismus screening
what is the test fro strabismus screening?
cover-uncover test
esotropia
one eye correctly looks straight, one looks inward
exotropia
one eye looks straight, the other looks outward
hypertropia
one eye looks straight, other looks up
objective vision screening test begins at what age?
3 yo
objective visual acuity testing consists of what?
Allen object recognition
E test
Snellen chart (letters)- when developmentally able
*failed tests require ophthalmologist referral
typical visual acuity at 6 months old
20/60
typical visual acuity at 3 years old
20/20 to 20/30
typical visual acuity at 3.5 years old
20/20 to 20/25
examples of ocular trauma
ecchymosis burn corneal abrasion hyphema globe rupture
examples of eyelid d/o’s
Blephritis
pediculosis
hoerdeolum (stye)- gland of Zeiss
chalazion- meibomian gland
Horner’s syndrome
miosis
ptosis
anhidrosis
corneal abrasion
abrasion causing corneal epithelium defect
painful
hx of FB (absent in newborns, whose hands are the culprit)
how do you check for a corneal abrasion?
fluorescein test
how do you tx a corneal abrasion?
Abx ointment
patching
cycoplegics
how do you prevent newborn corneal abrasions?
file down fingernails
what is the name given to bleeding in the anterior chamber of the eye?
hyphema
what is the typical cause of hyphemas?
direct trauma
also seen in coagulopathy
rise in intraocular pressure d/t hyphema raises the risk of what?
vision loss & optic n. atrophy
how to manage hyphema?
sickle cell status VERY important
immed. referral to ophthalmologist
serial anterior chamber pressure measurements
therapies include steroids, ocular O2, operative evacuation
most concerning syndrome when you see a retinal hemorrhage?
shaken baby syndrome
retinal hemorrhages may also be seen in?
coagulopathies
cardiopulmonary resuscitation
sudden changes in intracranial pressure
changes in intracranial pressure during delivery
hordeolum
acute, localized infxn of the eyelash follicles (glands of Zeiss, external) or meibomian glands (internal)
MCC of hordeolum
S. aureus
Hordeolum tx
warm compesses
referral to ophthalmologist if not improving in 2-3 days for drainage
Abx if inflammation appears to be spreading or w/ pre-auricular adenopathy or signs of bacteremia
chalazion
painless chronic inflammation (granuloma) of the lid involving tarsal sebaceous gland (meibomian gland)
a chalazion typically starts as a what?
hordeolum
how do you tx a chalazion?
warm compresses for up to 6 wks
referral to ophtho after 6 wks for removal
nasolacrimal duct obstruction
frequent-6% of infants
may open spontaneously
refer to ophtho if persistent to 1 yer of age, or w/ constant eye tearing & drainage
dacryocystocele
blue nodule inferior & medial to inner canthus
dacrocystitis
infected dacryocystocele
ophthalmia neonatorum
purulent conjunctivitis starting 1st 10 days of life
silver nitrate causes neonatal conjunctivitis (ack)
E. coli & other enteric gram-negative rods, HSV, others discussed separately
opthalmia neonatorum d/t Chlamydiae
high suspicion based on prenatal hx
risk is 25-50% if mother infected (risk of pneumonitis is 5-10%)
2 wks oral erythromycin
ophthalmia neonatorum d/t N. gonorrhoeae
copious eye d/c
ophthalmologic emergency
irrigate, systemic Abx (single dose ceftriaxone)
what Abx do you use to tx ophtalmia neonatroum d/t N. gonorrhoeae
single does ceftriaxone
bacterial conjunctivitis
purulent eye d/c
may be unilateral or bilateral
bacterial conjunctivitis causative pathogens
Streptococcus pneumoniae
nontypable Haemophilus influenzae
Psuedomonas aeurginosa
Pseudomonas aeurginosa is associated w/ what?
extended wear contact lenses
tx of bacterial conjunctivitis
topical: ciprofloxacin, trimethoprim-polymyxin B, sulfacetamide (stings), erythromycin
systemic tx depends on severity
viral conjunctivitis (“pink eye”)
watery to purulent eye d/c
sometimes difficult to distinguish from bacterial
*very contagious!!!
hand washing, often limits CH from school attendance
very common causes of viral conjunctivitis
enteroviruses
adenoviruses
tx of viral conjunctivitis
resolves usually w/ minimal intervention; refrain/limit use of Abx if viral conjunctivitis suspected (no pus, no fever, localized)
varicella & herpes simplex I & II may cause what?
viral conjunctivitis
keratitis
*refer for any cases of infxn around globe & concern for corneal involvement; also to r/o keratitis
sx’s of corneal ulcer
decreased vision pain scleral injection white corneal infiltrate *refer to ophtho d/t greater chance of scarring
what might you see in allergic conjunctivitis
boggy turbinates
Dennie-Morgan lines
transverse nasal crease
allergic shiners
allergic shiners
dark discoloration under eyes
swollen eyelids
associated sx’s w/ allergic conjunctivitis
allergic rhinitis
allergic sx’s
usually very itchy eyes
tx for allergic conjunctivitis
mast cell stabilizer
H1 receptor antagonist
what are some systemic causes of conjunctivitis
Kawasaki's dz SJS Reiter syndrome various auto-immune d/o's: SLE juvenile RA (causes anterior uveitis-iridocyclitis) Behcet dz Sjorgen's syndrome IBD
primary teeth begin to erupt when?
~6 months
early age for primary teeth to erupt
3-4 months
late age for primary teeth eruption
12-16 months
when should kid visit dentist for 1st time?
6 months after 1st teeth erupt
what do you call teeth present at birth?
supernumerary teeth
“real” primary teeth
why do you usually remove supernumerary teeth/ “real” primary teeth?
facilitate nursing
prevent ulceration, occlusion issues
eliminate risk of aspiration
what can you use for teething pain?
teething rings & biscuits
cold rag massage
systemic analgesia
topical “teething gel” discouraged
systemic analgesia for teething pain
acetaminophen
ibuprofen (over 6 months of age)
why is topical teething gel discouraged?
may cause excessive numbness & impair gag reflex and airway protection
overdose may lead to methemoglobinemia
what are some of the causes of dental caries?
bacteria
simple carbs (substrate for bacteria)
acidic environment
name some of the bacteria responsible for dental caries?
viridans streptococci
streptococcus mutans
others
strategies to prevent dental caries
fluoride- in H2O, direct application
minimizing oral flora
eliminate carbs (simple & complex-amylase)
how do you minimize oral flora?
gently rub teeth
brushing-2 min, at least 1x/day
flossing- start before preschool period to acclimate CH to habit
acceptable level of fluoride in drinking water for age 6 month to 3 yo
0.25 mg/d if < 0.3 ppm
acceptable level of fluoride in drinking water for age 3-6 yo
- 5 mg/d if < 0.3 ppm
0. 25 mg/d if 0.3-0.6 ppm
acceptable level of fluoride in drinking water for age 6-16 yo
1 mg/d if <0.3 ppm
0.5 mg/d if 0.3-0.6 ppm
dental trauma- avulsion
primary dentition not replanted
permanent dentition may be replaced (save tooth in cold milk or NS; replace in alveolar bone in 1 hr)
evaluating fractured teeth
enamel- tooth cleaned & shaped
enamel & dentin- tooth protected
exposed pulp- pulpotomy or pulpectomy
dental Abx prophylaxis
certain pt groups require prophylactic Abx coverage during invasive dental procedures
-CH w/ heart dz, immunocompromised
what is the MCC of viral URI?
rhinoviruses (10-40%)
coronaviruses (~20%)
CH < 6 yo typically have how many colds/yr?
6-8
w/ avg sx duration of 14 days
URI infnxs are most contagious when?
1st 2-4 days
T or F: a child may have cold sx’s up to 1/2 of all days between Sept & April & sitll have a nml frequency & duration of colds
TRUE
what are the most effective means of preventing URI’s?
hand washing
alcohol gels
fluids in URI
not extra fluids, but encourage fluids to prevent dehydration
no ibuprofen under what age?
6 months
no aspirin under what age?
18 yo
what can you do for nasal passages in URI?
nasal bulb suction or wash
Complications of URI that need to be watched
otitis media (viral or bacterial)
bacterial conjunctivitis, sinusitis, pneumonia
asthma exacerbation
dehydration
have zinc, vitamin C or echinacea been proven effective in the tx of URI?
no
FDA recommends against the use of what in CH < 6yo w/ URI?
decongestants
expectorants
cough suppressants
*no definitive proof of efficacy
what may be of slight benefit to CH > 12 months old w/ URI?
antihistamines
AAP policy statement against the use of what in URI?
dextromethorphan
codeine
causes of bacterial pharyngitis
Group A strep (~10%)
other beta-hemolytic strep (groups C,D,G)
gonococcus
general causes of pharyngitis
viral bacterial allergic chemical traumatic (bulimia) weird: PFAPA
classic sx’s of S. pyogenes (GAS) pharyngitis
fever beefy red pharyngitis \+/- palatal petechiae \+/- tonsillar exudate \+/- strawberry tongue tender cervical adenopathy H/A abdominal pain +/- vomiting lasts 3-5 days w/o tx
complications of S. pyogenes (GAS) pharyngitis
bacterial cervical lymphadenitis
peritonsillar or retropharyngeal abscess
scarlet fever
s/sx of scarlet fever
sandpaper rash 1-2 days after start of pharyngitis
Pastia’s lines- intense erythema of axillae & groin
immune complications of S. pyogenes (GAS) pharyngitis several wks later
acute rheumatic fever
glomerulonephritis
various scoring systems use criteria to predict chance that GAS is causative of pharyngitis
age 5-15 season late fall, winter, early spring evidence of acute pharyngitis tender, enlarged, cervical lymph nodes middle grade fever absence of usual S&S assoc. w/ viral URTI (no cough, rhinorrhea, nasal congestion)
reasons to ID & tx S. pyogenes (GAS) pharyngitis
prevents suppurative complications prevents streptococcal toxic shock prevents acute rheumatic fever (post-streptococcal glomerulonephritis is not prevented by Abx) prevents transmission prevents overuse of Abx
what tests can you use to test for S. pyogenes (GAS) pharyngitis
rapid antigen detection test (75-85% sensitive)
beta-hemolytic strep throat cx- higher sensitivity, results may take 1-2 days
tx for S. pyogenes (GAS) pharyngitis is?
PCN or IM benzathine PCN
other beta-lactams, azithromycin & clindamycin also used
when should a formal hearing eval be done in kids w/ hx of AOM
OM w/ effusion for more than 3 months
4+ episodes of AOM in 6 months
ethmoid & maxillary sinuses are present & pneumatized when?
at birth
frontal & sphenoid sinuses form & pneumatize when?
in preschool or early school age
what do you call inflammation of the paranasal sinuses that can have a viral, allergic, or bacterial origin?
sinusitis
what are the s/sx of sinusitis
severe cold sx’s: fever +/- mucopurulent nasal d/c
persistent (> 2wks) respiratory sx’s: +/- nasal d/c, H/A, facial pressure, tooth pain on heelstrike, cough, halitosis
how do you typically dx sinusitis?
typically clinically
though sinus films or CT may have some role in equivocal cases
tx of sinusitis
nearly 50% will resolve on own
tx reserved for persistant sx’s/ worsening severity
tx Rx for 2-3 wks
recurrent/chronic may require surgical intervention, consideration of fungal causes
preseptal (periorbital) & postseptal (orbital) cellulitis MC presention is?
eye swelling
DDx for periorbital & orbital cellulitis
infxn- preseptal & postseptal cellulitis trauma- "black eye" edema- angioedema, CHF, hypoalbuminemia allergy- allergic conjunctivitis tumor- neuroblastoma, retinoblastoma, rhabdomysarcoma
preseptal (periorbital) cellulitis caused by?
extension of localized infxn: conjunctivitis hordeolum dacryoadenitis dacrocystitis *often a complication of acute sinusitis/ trauma
postseptal (orbital) cellulitis is a complication of?
acute sinusitis or trauma
hematogenous spread
orbital infxn can cause permanent?
visual impairment
postseptal cellulitis suspected w/ signs of orbital infiltration…
proptosis
impairment of extra-ocular eye mvnts
pain w/ eye mvnt (ophthalmoplegia)
loss of visual acuity
organisms to consider for tx in preseptal & postseptal cellulitis
S. aureus S. pyogenes S. pneumonia H. influenzae M. catarrhalis with abscess-anaerobes postpartum- gonococcus & C. trachomatis
otits externa is aka?
swimmer’s ear
otitis externa is associated w/?
swimming
diving
tympanostomy tubes
s/sx of otitis externa
typically fever
tenderness w/ mvnt of pinna, esp. tragus
swollen, tender external auditory canal, often w/ purulent d/c: easily confused w/ otitis media w/ TM perforation. Malignant OE may have granulomatous tissue in EAC; occasionally w/ facial n. palsy
malignant OE caused by?
P. aeurignosa
typical tx for OE?
topical quinolone, 2% acetic acid irrigation
malignant OE tx w/?
systemic IV Abx
mngt of OE
avoidance of cause: earlplugs, special diving equipment
drying the EAC after swimming/diving may be used as prophylaxis- isopropanol, 2% acetic acid, or Burow soln
mastoiditis
inflammation of the air cells & tissue surrounding the mastoid process of the temporal bone
classic findings of mastoiditis
fever, post-auricular pain
presence or recent hx of AOM
anterior, downward, lateral displacement of pinna
mastoiditis etiologies
S. pneumoniae
S. pyogenes (Group A beta-hemolytic strep)
S. aureus
Haemophilus influenzae
tx of mastoiditis
hospitalization
IV Abx- ceftriaxone, clindamycin
may require mastoidectomy
complications of mastoiditis
meningitis
facial n. palsy
cavernous sinus thrombosis
thrombophlebitis
clinical sx’s of URI
fever for up to 3 days
cough, nasal & pharyngeal sx’s for 7-21 days
color of nasal mucus is not important
