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Peds-Final > Ophtho, Dentistry, Otolaryngology > Flashcards

Ophtho, Dentistry, Otolaryngology Flashcards

1
Q

what is a strabismus?

A

misalignment of the visual pathway

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2
Q

strabismus defects always present are called?

A

tropias

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3
Q

strabismus defects found on provocative testing?

A

phorias

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4
Q

the majority of strabismus cases occur bet. the ages of?

A

18 months & 6 yo

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5
Q

what will the developing brain do if it is receiving poor-quality visual information from one side (strabismus, cataract, etc)?

A

it will suppress the information from the abnormal side

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6
Q

visual sensory deprivation leads to what?

A

chronic visual loss on the affected side

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7
Q

what do you call a chronic visual loss related to dz of visual pathways?

A

amblyopia

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8
Q

amblyopia leads to what?

A

reduction in central visual acuity

accounts for 20-70% of visual loss in adults

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9
Q

40% of children w/ strabismus will develop what?

A

amblyopia

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10
Q

vision screening is subjectively screened up to what age?

A

3 months of age

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11
Q

vision screening in infancy

A 
red reflex
fixation & tracking (approp. for age)
test of pupillary refelx
corneal light reflex
blink to threat
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12
Q

what do you assess for when checking red reflex?

A

cataracts & intraglobular tumors

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13
Q

vision screening between 6 months to 3 years of age

A

fixation & tracking
test of pupillar reflex (if child allows)
corneal light replex
strabismus screening

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14
Q

what is the test fro strabismus screening?

A

cover-uncover test

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15
Q

esotropia

A

one eye correctly looks straight, one looks inward

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16
Q

exotropia

A

one eye looks straight, the other looks outward

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17
Q

hypertropia

A

one eye looks straight, other looks up

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18
Q

objective vision screening test begins at what age?

A

3 yo

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19
Q

objective visual acuity testing consists of what?

A

Allen object recognition
E test
Snellen chart (letters)- when developmentally able
*failed tests require ophthalmologist referral

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20
Q

typical visual acuity at 6 months old

A

20/60

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21
Q

typical visual acuity at 3 years old

A

20/20 to 20/30

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22
Q

typical visual acuity at 3.5 years old

A

20/20 to 20/25

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23
Q

examples of ocular trauma

A 
ecchymosis
burn
corneal abrasion
hyphema
globe rupture
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24
Q

examples of eyelid d/o’s

A

Blephritis
pediculosis
hoerdeolum (stye)- gland of Zeiss
chalazion- meibomian gland

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25
Q

Horner’s syndrome

A

miosis
ptosis
anhidrosis

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26
Q

corneal abrasion

A

abrasion causing corneal epithelium defect
painful
hx of FB (absent in newborns, whose hands are the culprit)

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27
Q

how do you check for a corneal abrasion?

A

fluorescein test

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28
Q

how do you tx a corneal abrasion?

A

Abx ointment
patching
cycoplegics

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29
Q

how do you prevent newborn corneal abrasions?

A

file down fingernails

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30
Q

what is the name given to bleeding in the anterior chamber of the eye?

A

hyphema

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31
Q

what is the typical cause of hyphemas?

A

direct trauma

also seen in coagulopathy

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32
Q

rise in intraocular pressure d/t hyphema raises the risk of what?

A

vision loss & optic n. atrophy

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33
Q

how to manage hyphema?

A

sickle cell status VERY important
immed. referral to ophthalmologist
serial anterior chamber pressure measurements
therapies include steroids, ocular O2, operative evacuation

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34
Q

most concerning syndrome when you see a retinal hemorrhage?

A

shaken baby syndrome

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35
Q

retinal hemorrhages may also be seen in?

A

coagulopathies
cardiopulmonary resuscitation
sudden changes in intracranial pressure
changes in intracranial pressure during delivery

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36
Q

hordeolum

A

acute, localized infxn of the eyelash follicles (glands of Zeiss, external) or meibomian glands (internal)

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37
Q

MCC of hordeolum

A

S. aureus

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38
Q

Hordeolum tx

A

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

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39
Q

chalazion

A

painless chronic inflammation (granuloma) of the lid involving tarsal sebaceous gland (meibomian gland)

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40
Q

a chalazion typically starts as a what?

A

hordeolum

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41
Q

how do you tx a chalazion?

A

warm compresses for up to 6 wks

referral to ophtho after 6 wks for removal

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42
Q

nasolacrimal duct obstruction

A

frequent-6% of infants
may open spontaneously
refer to ophtho if persistent to 1 yer of age, or w/ constant eye tearing & drainage

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43
Q

dacryocystocele

A

blue nodule inferior & medial to inner canthus

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44
Q

dacrocystitis

A

infected dacryocystocele

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45
Q

ophthalmia neonatorum

A

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

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46
Q

opthalmia neonatorum d/t Chlamydiae

A

high suspicion based on prenatal hx
risk is 25-50% if mother infected (risk of pneumonitis is 5-10%)
2 wks oral erythromycin

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47
Q

ophthalmia neonatorum d/t N. gonorrhoeae

A

copious eye d/c
ophthalmologic emergency
irrigate, systemic Abx (single dose ceftriaxone)

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48
Q

what Abx do you use to tx ophtalmia neonatroum d/t N. gonorrhoeae

A

single does ceftriaxone

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49
Q

bacterial conjunctivitis

A

purulent eye d/c

may be unilateral or bilateral

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50
Q

bacterial conjunctivitis causative pathogens

A

Streptococcus pneumoniae
nontypable Haemophilus influenzae
Psuedomonas aeurginosa

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51
Q

Pseudomonas aeurginosa is associated w/ what?

A

extended wear contact lenses

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52
Q

tx of bacterial conjunctivitis

A

topical: ciprofloxacin, trimethoprim-polymyxin B, sulfacetamide (stings), erythromycin
systemic tx depends on severity

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53
Q

viral conjunctivitis (“pink eye”)

A

watery to purulent eye d/c
sometimes difficult to distinguish from bacterial
*very contagious!!!
hand washing, often limits CH from school attendance

54
Q

very common causes of viral conjunctivitis

A

enteroviruses

adenoviruses

55
Q

tx of viral conjunctivitis

A

resolves usually w/ minimal intervention; refrain/limit use of Abx if viral conjunctivitis suspected (no pus, no fever, localized)

56
Q

varicella & herpes simplex I & II may cause what?

A

viral conjunctivitis
keratitis
*refer for any cases of infxn around globe & concern for corneal involvement; also to r/o keratitis

57
Q

sx’s of corneal ulcer

A 
decreased vision
pain
scleral injection
white corneal infiltrate
*refer to ophtho d/t greater chance of scarring
58
Q

what might you see in allergic conjunctivitis

A

boggy turbinates
Dennie-Morgan lines
transverse nasal crease
allergic shiners

59
Q

allergic shiners

A

dark discoloration under eyes

swollen eyelids

60
Q

associated sx’s w/ allergic conjunctivitis

A

allergic rhinitis
allergic sx’s
usually very itchy eyes

61
Q

tx for allergic conjunctivitis

A

mast cell stabilizer

H1 receptor antagonist

62
Q

what are some systemic causes of conjunctivitis

A 
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
63
Q

primary teeth begin to erupt when?

A

~6 months

64
Q

early age for primary teeth to erupt

A

3-4 months

65
Q

late age for primary teeth eruption

A

12-16 months

66
Q

when should kid visit dentist for 1st time?

A

6 months after 1st teeth erupt

67
Q

what do you call teeth present at birth?

A

supernumerary teeth

“real” primary teeth

68
Q

why do you usually remove supernumerary teeth/ “real” primary teeth?

A

facilitate nursing
prevent ulceration, occlusion issues
eliminate risk of aspiration

69
Q

what can you use for teething pain?

A

teething rings & biscuits
cold rag massage
systemic analgesia
topical “teething gel” discouraged

70
Q

systemic analgesia for teething pain

A

acetaminophen

ibuprofen (over 6 months of age)

71
Q

why is topical teething gel discouraged?

A

may cause excessive numbness & impair gag reflex and airway protection
overdose may lead to methemoglobinemia

72
Q

what are some of the causes of dental caries?

A

bacteria
simple carbs (substrate for bacteria)
acidic environment

73
Q

name some of the bacteria responsible for dental caries?

A

viridans streptococci
streptococcus mutans
others

74
Q

strategies to prevent dental caries

A

fluoride- in H2O, direct application
minimizing oral flora
eliminate carbs (simple & complex-amylase)

75
Q

how do you minimize oral flora?

A

gently rub teeth
brushing-2 min, at least 1x/day
flossing- start before preschool period to acclimate CH to habit

76
Q

acceptable level of fluoride in drinking water for age 6 month to 3 yo

A

0.25 mg/d if < 0.3 ppm

77
Q

acceptable level of fluoride in drinking water for age 3-6 yo

A
  1. 5 mg/d if < 0.3 ppm

0. 25 mg/d if 0.3-0.6 ppm

78
Q

acceptable level of fluoride in drinking water for age 6-16 yo

A

1 mg/d if <0.3 ppm

0.5 mg/d if 0.3-0.6 ppm

79
Q

dental trauma- avulsion

A

primary dentition not replanted

permanent dentition may be replaced (save tooth in cold milk or NS; replace in alveolar bone in 1 hr)

80
Q

evaluating fractured teeth

A

enamel- tooth cleaned & shaped
enamel & dentin- tooth protected
exposed pulp- pulpotomy or pulpectomy

81
Q

dental Abx prophylaxis

A

certain pt groups require prophylactic Abx coverage during invasive dental procedures
-CH w/ heart dz, immunocompromised

82
Q

what is the MCC of viral URI?

A

rhinoviruses (10-40%)

coronaviruses (~20%)

83
Q

CH < 6 yo typically have how many colds/yr?

A

6-8

w/ avg sx duration of 14 days

84
Q

URI infnxs are most contagious when?

A

1st 2-4 days

85
Q

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

A

TRUE

86
Q

what are the most effective means of preventing URI’s?

A

hand washing

alcohol gels

87
Q

fluids in URI

A

not extra fluids, but encourage fluids to prevent dehydration

88
Q

no ibuprofen under what age?

A

6 months

89
Q

no aspirin under what age?

A

18 yo

90
Q

what can you do for nasal passages in URI?

A

nasal bulb suction or wash

91
Q

Complications of URI that need to be watched

A

otitis media (viral or bacterial)
bacterial conjunctivitis, sinusitis, pneumonia
asthma exacerbation
dehydration

92
Q

have zinc, vitamin C or echinacea been proven effective in the tx of URI?

A

no

93
Q

FDA recommends against the use of what in CH < 6yo w/ URI?

A

decongestants
expectorants
cough suppressants
*no definitive proof of efficacy

94
Q

what may be of slight benefit to CH > 12 months old w/ URI?

A

antihistamines

95
Q

AAP policy statement against the use of what in URI?

A

dextromethorphan

codeine

96
Q

causes of bacterial pharyngitis

A

Group A strep (~10%)
other beta-hemolytic strep (groups C,D,G)
gonococcus

97
Q

general causes of pharyngitis

A 
viral
bacterial
allergic
chemical
traumatic (bulimia)
weird: PFAPA
98
Q

classic sx’s of S. pyogenes (GAS) pharyngitis

A 
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
99
Q

complications of S. pyogenes (GAS) pharyngitis

A

bacterial cervical lymphadenitis
peritonsillar or retropharyngeal abscess
scarlet fever

100
Q

s/sx of scarlet fever

A

sandpaper rash 1-2 days after start of pharyngitis

Pastia’s lines- intense erythema of axillae & groin

101
Q

immune complications of S. pyogenes (GAS) pharyngitis several wks later

A

acute rheumatic fever

glomerulonephritis

102
Q

various scoring systems use criteria to predict chance that GAS is causative of pharyngitis

A 
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)
103
Q

reasons to ID & tx S. pyogenes (GAS) pharyngitis

A 
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
104
Q

what tests can you use to test for S. pyogenes (GAS) pharyngitis

A

rapid antigen detection test (75-85% sensitive)

beta-hemolytic strep throat cx- higher sensitivity, results may take 1-2 days

105
Q

tx for S. pyogenes (GAS) pharyngitis is?

A

PCN or IM benzathine PCN

other beta-lactams, azithromycin & clindamycin also used

106
Q

when should a formal hearing eval be done in kids w/ hx of AOM

A

OM w/ effusion for more than 3 months

4+ episodes of AOM in 6 months

107
Q

ethmoid & maxillary sinuses are present & pneumatized when?

A

at birth

108
Q

frontal & sphenoid sinuses form & pneumatize when?

A

in preschool or early school age

109
Q

what do you call inflammation of the paranasal sinuses that can have a viral, allergic, or bacterial origin?

A

sinusitis

110
Q

what are the s/sx of sinusitis

A

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

111
Q

how do you typically dx sinusitis?

A

typically clinically

though sinus films or CT may have some role in equivocal cases

112
Q

tx of sinusitis

A

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

113
Q

preseptal (periorbital) & postseptal (orbital) cellulitis MC presention is?

A

eye swelling

114
Q

DDx for periorbital & orbital cellulitis

A 
infxn- preseptal & postseptal cellulitis
trauma- "black eye"
edema- angioedema, CHF, hypoalbuminemia
allergy- allergic conjunctivitis
tumor- neuroblastoma, retinoblastoma, rhabdomysarcoma
115
Q

preseptal (periorbital) cellulitis caused by?

A 
extension of localized infxn:
conjunctivitis
hordeolum
dacryoadenitis
dacrocystitis
*often a complication of acute sinusitis/ trauma
116
Q

postseptal (orbital) cellulitis is a complication of?

A

acute sinusitis or trauma

hematogenous spread

117
Q

orbital infxn can cause permanent?

A

visual impairment

118
Q

postseptal cellulitis suspected w/ signs of orbital infiltration…

A

proptosis
impairment of extra-ocular eye mvnts
pain w/ eye mvnt (ophthalmoplegia)
loss of visual acuity

119
Q

organisms to consider for tx in preseptal & postseptal cellulitis

A 
S. aureus
S. pyogenes
S. pneumonia
H. influenzae
M. catarrhalis
with abscess-anaerobes
postpartum- gonococcus & C. trachomatis
120
Q

otits externa is aka?

A

swimmer’s ear

121
Q

otitis externa is associated w/?

A

swimming
diving
tympanostomy tubes

122
Q

s/sx of otitis externa

A

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

123
Q

malignant OE caused by?

A

P. aeurignosa

124
Q

typical tx for OE?

A

topical quinolone, 2% acetic acid irrigation

125
Q

malignant OE tx w/?

A

systemic IV Abx

126
Q

mngt of OE

A

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

127
Q

mastoiditis

A

inflammation of the air cells & tissue surrounding the mastoid process of the temporal bone

128
Q

classic findings of mastoiditis

A

fever, post-auricular pain
presence or recent hx of AOM
anterior, downward, lateral displacement of pinna

129
Q

mastoiditis etiologies

A

S. pneumoniae
S. pyogenes (Group A beta-hemolytic strep)
S. aureus
Haemophilus influenzae

130
Q

tx of mastoiditis

A

hospitalization
IV Abx- ceftriaxone, clindamycin
may require mastoidectomy

131
Q

complications of mastoiditis

A

meningitis
facial n. palsy
cavernous sinus thrombosis
thrombophlebitis

132
Q

clinical sx’s of URI

A

fever for up to 3 days
cough, nasal & pharyngeal sx’s for 7-21 days
color of nasal mucus is not important

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