Pediatric EENT

Question 1

Common staphylococcal abscess on upper or lower eyelid

Answer 1

Hordeolum (stye)

Question 2

Stye S/S

Answer 2

Hordeolum
-abrupt onset
-localized pain (acutely tender) and tender

*localized warm compress several times a day

Question 3

Chalazion

Answer 3

beady nodule on eyelid, infection or retention cyst of the meibomian gland

*hard, non-tender cyst
*painless

-may cause visual distortion if the cyst is large to impress cornea, may cause astigmatism (blurry vision)

-Surgery for removal

Question 4

Conjunctivitis

Answer 4

purulent discharge=bacterial
tx: erythromycin 0.5% ophthalmic ointment

*DO NOT USE STERIODS B/C INCREASED INTRAOCULAR PRESSURE AND ACTIVATION OF HERPES SIMPLEX

Question 5

Cataracts in pediatrics

Answer 5

progressive opacity of the eye
-clouded, blurred, dim vision
-white fungus reflex( absent red reflex)
-refer for surgical removal

Question 6

Strabismus

Answer 6

ocular misalignment of uncoordinated ocular muscles
-check CCN 3,4,6
-Esotropia: inward
-Exotropia: outward
-Hypertropia:upward
-Hypotropia: downward

-Hirschberg pupillary light reflex
is unequal

-refer to ophthalmology (H follows hand H)

Question 7

inflammation of external auditory meatus

Answer 7

Swimmers ear/ Otitis externa
-tympanic membrane is normal

Tx:
Ciprofloxacxin and dexamethasone otic drops
Ofloxacin otic drops

*eye drops for ears ok! ear drops not for eyes!!
has steroids in mix not okay for eyes!!!

Question 8

Acute Otitis Media (AOM)

Answer 8

Streptococcus Pneumoniae
Haemophilus influenza

-Tympanic membrane often bulges

Tx: watchful waiting 48-72hours

-Amoxicillin 80-90mg/kg/day, BID oral for 10 days
(no ABX in last 30 days)
-Amoxicillin-clavulante recommended for resistant strains

Question 9

Presence of fluid in middle ears w/out signs and symptoms of AOM

Answer 9

Serious Otitis Media/ Otitis Media w/ Effusion (OME)

S/S
hearing loss
Fullness in ear
-Weber and Rhinne test suggestive of CONDUCTIVE hearing loss

Tx:
watchful monitoring 3months

Question 10

types of hearing loss

Answer 10

conductive
sensineural
mixed

Question 11

Decreased ability to conduct sound from external to inner ear

Answer 11

Conductive hearing loss
-Cerumen impaction/ foreign body
*sound lateralize to right ear=foreign body
-hematoma
-otitis media
-perforated TM

Question 12

Sensorineural Hearing loss

Answer 12

impaired transmission of sound through nervous system

causes:
*syphilis
*Medication toxicity
-acoustic neuroma
-CNS disease

Question 13

what test: sound should be heard equally in both ear and not lateralize (means to move towards)

Answer 13

Weber Test
-tuning fork on top of head

Question 14

what test: air conduction (AC) > bone conduction (BC)

Answer 14

Rhinne Test
-tuning for at ear

Question 15

during weber test sound lateralizes to affected ear? which hearing loss?

Answer 15

Conductive hearing loss

Question 16

during Weber test sound lateralize to unaffected ear? which hearing loss?

Answer 16

Sensorineural hering loss

Question 17

during rhinne test, abnormal sound in affected ear (AC<BC). which hearing loss

Answer 17

Conductive hearing loss

Question 18

during Rhinne test, normal in the affected ear, which hearing loss?

Answer 18

Sensorineural

Question 19

Viral Rhinitis

Answer 19

AKA common cold
-rest and hydration
-no ABX

Question 20

Sinusitis (rhinosinusitis)

Answer 20

caused by.
S. pneumoniae
H. influenzae
M. catarrhalis

S/S
teeth hurt/ dull throbbing pain worsening when head is dependent

Dx made on clinical presentation

Tx
Amoxillin-clavulante for 10 days
(if no ABX in past 30 days)

Question 21

Epitaxis

Answer 21

S/S
Friable (touches and bleeds), possible septal erosion caused by inhaled substances

Management:
-Sit upright
*pressure at Kiesselbach’s plexus (i.e triangle): anterior inferior aspect of the nasal septum
(end of bony ridge) for 10 min
-apply ice

Question 22

Pharyngitis/ Tonsilitis

Answer 22

ABX only for streptocccal Infection
-penicillin VK 250mg orally 2-3times daily for 10days

Question 23

Epiglotitis

Answer 23

Sudden severe swelling of the epiglottis from bacterial infection

*DROOLING
*THUMB SIGN - thumb-shape appearance on XR of neck
*IMMEDIATE HOSPITALIZATION
-do not perform a pharyngeal exam

Question 24

Croup

Answer 24

Parainfluenza viral infection of the larynx
peaks 6months-3years

-bark like cough
-if stridor, red flag, severe
-*STEEPLE SHAPE appearance, narrowing of the trachea on XR of neck

Question 25

Infectious Mononucleosis

Answer 25

-infection due to Epstein-Barr virus (EBV)
-ages 15-25

Physical exam
-Posterios cervical lymadenopathy
-splenomegaly (no contact sports 3weeks to several months)

*anterior cervical lymadenopathy = strep