Pediatric EENT

Question 1

In strabismus, what is the suffix for eye misalignment that is always present?

Answer 1

-tropia

Question 2

In strabismus, what is the suffix for eye misalignment that is intermittent, such as when binocular fixation is interrupted?

Answer 2

-phoria

Question 3

A strabismus that is deviated outward is _______?

Answer 3

-Exo

Question 4

A strabismus that is deviated inward is an ____________?

Answer 4

-Eso

Question 5

a strabismus that is deviated down or up is __________?

Answer 5

-hypo or -hyper

Question 6

ophthalmia neonatorum is what?

Answer 6

inflammation in the eye of the neonate

Question 7

when does ophthalmalogic neisseria gonorrhoeae usually present?

Answer 7

typically within 2-5 days of age

with swelling of lids and conjunctivae

copious purulent discharge

Question 8

what type of conjunctivitis is rare in the neonate, but can be vision-threatening if untreated?

Answer 8

viral conjunctivitis with HSV

Question 9

what is the most common cause of tearing in children?

Answer 9

nasolacrimal duct obstruction (dacryostenosis)

Question 10

what are the risk factors for acute otitis media in an infant?

Answer 10

tobacco exposure

use of a pacifier

formula fed

fed lying down

daycare attendance

imcomplete immunizations

younger age

mild hereditary risk

Question 11

why is the color of the TM not particularly diagnostic in pediatric patients?

Answer 11

Because they are probably flushed from screaming and turning their TMs red

Question 12

What is the most specific finding in diagnosing AOM?

Answer 12

moderate to severe bulging of the TM

better yet, impaired motility with pneumatic otoscopy or tympanogram

Question 13

What are the most common pathogens in AOM in children?

Answer 13

• S. pneumoniae: 35-50% (50% resistance to PCN)
• Non-typeable H influenza: 30-40% (40%+ β lactamase)
• Moraxella catarrhalis: 15% (All β lactamase)
• S pyogenes: 5%, more common older children
• Viruses: RSV, parainfluenza, influenza
• usually starts as a viral URI

Question 14

What are the 2013 AAP Guidelines on Treating AOM in children?

Answer 14

sever symptoms include: toxic appearing child; persistent otalgia > 48 hours, temperature > 102.2 in last 48 hours or uncertain access to follow-up

Question 15

If you take the approach of watchful waiting, when must you follow up?

Answer 15

48-72 hours

up to 1/3 will need abx

Question 16

What is first line therapy in AOM in pediatrics?

Answer 16

High dose amoxicillin is first line therapy

80-90 mg/kg/day divided into 2 daily doses

Treat with augmention if:

• purulent conjunctivitis (H Flu)
• treated with amoxicillin in last 30 days
• fails treatment with amoxicillin

Question 17

What is the only antibiotic for which IgE mediated testing is available?

Answer 17

penecillians and nothing else!

negative skin test 97-99% negative predictive value

Question 18

When does a child need ENT referral for tympanostomy tubes?

Answer 18

3 or more episodes of AOM within 6 mos.

OR

4 episodes in the last year with 1 in the last 6 mos.

children younger than 6 mos. may warrant a more aggressive approach

Question 19

what is the most common pediatric infectious disease?

Answer 19

viral rhinitis

Question 20

what is the average progression of viral rhinitis?

Answer 20

Average duration is 7-9 days, but sometimes up to 15 days

fever usually resolves by the 3rd day

symptoms tend to peak on the 3rd day

frequently cough lasts longer

Question 21

what disorder that is common in adults is not common in children?

Answer 21

sinusitis

sinuses not completely developed until 20 years of age

Question 22

what is a PE sign of allergic rhinitis in a child?

Answer 22

crease in the bridge of the nose from chronic wiping

does not typically present until 10-12 months at earliest

(3-4 years of age for seasonal)

Question 23

what can be a dangerous drug to give for allergic rhinitis?

Answer 23

benadryl - or any 1st gen. antihistamines

Question 24

What do you use to grade size of tonsils?

Answer 24

Broadsky Grading Scale or measurement of distance between tonsilar pillars

Question 25

should you do a direct exam to confirm a diagnosis of epligotitis?

Answer 25

No, unless you are an airway expert and are ready to intubate the pediatric patient in laryngospasm

Question 26

penlight test findings

Answer 26

Question 27

cover-uncover test

Answer 27

Question 28

At what age should you refer a child with strabismus to ophthalmology?

Answer 28

\>4 months

Question 29

what is chemical conjunctivitis?

Answer 29

onset of erythema and watery discharge in the first 24 hours of life that is reaction to neonatal eyedrops -symptoms resolve in days without treatment

Question 30

what's the treatment for neisseria opthalmicus?

Answer 30

ceftriaxone ophthalmology referral screen and treat parents

Question 31

what is the presentation of chlamydia ophthalmia?

Answer 31

4-19 days of age mild swelling of the lids and conjuctivae hyperemia scant purulent discharge \*can develop pneumonitis

Question 32

what's the treatment for chlamydia?

Answer 32

erythromycin treat empirically for gonorrhea co-infection screen and treat parents

Question 33

what is the presentation of HSV ophthalmia?

Answer 33

typically unilateral within 2-4 weeks of life vesicular lid lesions \*corneal disease can threaten vision

Question 34

what is the treatment for HSV ophthalmia?

Answer 34

acyclovir

Question 35

what is the most common cause of tearing in children?

Answer 35

dacryostenosis (nasolacrimal duct obstruction) 20% of newborns 6% of children in 1st year

Question 36

what is the management of dacryostenosis?

Answer 36

non-surgical observation lacrimal sac massage may help refer to ophtho if not resolved by six months

Question 37

what is the treatment of otorrhea in children with tympanostomy tuves

Answer 37

only FDA approved: fluroquinolone drops (cipro and ofloxacin)

Question 38

when should you refer a child for tympanostomy tubes who has otitis media with effusion

Answer 38

if no resolution in 3 months

Question 39

what does the diagnosis of sinusitis in a pediatric patient require?

Answer 39

* synptoms present for \>10 days without improvement or * symptoms worsen with new onset fever or cough or * be associated with temperatures \>39 C for more than 3 days

Question 40

what's the presentation of mono?

Answer 40

tonsillar exudates cervical lymphadenopathy (posterior chian) fever +/- spleen enlargement

Question 41

what do you have to watch with hand, foot, and mouth? coxasackievirus

Answer 41

hydration status

Question 42

what's the tell-tale sign of hand, foot and mouth?

Answer 42

ulcerations in posterior pharynx surrounded by a halo

Question 43

what's the presentation of strep throat?

Answer 43

fever, sore throat tender cervical lymphadenopathy erythematous posterior pharynx +/- exudate and petechiae N/V, headache young children may have nasal congestion

Question 44

what's the Centor 4 point scale to diagnose strep throat?

Answer 44

fever absence of cough anterior cervical adenopathy tonsilar exudates

Question 45

what are two signs of scarlet fever?

Answer 45

strawberry tongue scarlantiform rash on trunk

Question 46

why do we treat strep?

Answer 46

prevent abscesses acute glomerulonephritis rheumatic fever and PANDAS

Question 47

what are the Paradise criteria for tonsillectomy?

Answer 47

sore throat episodes: temperature \>38.3, cervical lymphadenopathy, or tonsillar exudate, positive culture for Group A strep 7 or more episodes in past year OR 5 or more episodes in the past 2 years 3 or more episodes in the past 3 years

Question 48

what is the treatment for epiglotitis?

Answer 48

IV ceftriaxone or cephalosporin endotracheal intubation - extubation 24-48 hours after reduction in swelling

Question 49

what's the treatment for severe cases of croup?

Answer 49

mild croup is managed with supportive care (fluids, mist) glucocorticoids (dex 0.6 mg/kg Im improves symptoms) oral 0.15 mg/kg may be effective for mild/moderate nebulized racemic epi - ED reduces intubations O2

Question 50

what is the causative organism of croup?

Answer 50

parainfluenza types 1 and 2 1 peaks every other autumn 2 has annual peaks direct contact, fomites, droplets

Question 51

what's the epi of croup?

Answer 51

6 to 36 months of age biggest group rare beyond 6 years

Question 52

how do you treat a perforated TM?

Answer 52

oflaxacin or cipro drops