Pediatric EENT Flashcards
In strabismus, what is the suffix for eye misalignment that is always present?
-tropia
In strabismus, what is the suffix for eye misalignment that is intermittent, such as when binocular fixation is interrupted?
-phoria
A strabismus that is deviated outward is _______?
-Exo
A strabismus that is deviated inward is an ____________?
-Eso
a strabismus that is deviated down or up is __________?
-hypo or -hyper
ophthalmia neonatorum is what?
inflammation in the eye of the neonate
when does ophthalmalogic neisseria gonorrhoeae usually present?
typically within 2-5 days of age
with swelling of lids and conjunctivae
copious purulent discharge
what type of conjunctivitis is rare in the neonate, but can be vision-threatening if untreated?
viral conjunctivitis with HSV
what is the most common cause of tearing in children?
nasolacrimal duct obstruction (dacryostenosis)
what are the risk factors for acute otitis media in an infant?
tobacco exposure
use of a pacifier
formula fed
fed lying down
daycare attendance
imcomplete immunizations
younger age
mild hereditary risk
why is the color of the TM not particularly diagnostic in pediatric patients?
Because they are probably flushed from screaming and turning their TMs red
What is the most specific finding in diagnosing AOM?
moderate to severe bulging of the TM
better yet, impaired motility with pneumatic otoscopy or tympanogram
What are the most common pathogens in AOM in children?
- 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
What are the 2013 AAP Guidelines on Treating AOM in children?
sever symptoms include: toxic appearing child; persistent otalgia > 48 hours, temperature > 102.2 in last 48 hours or uncertain access to follow-up
If you take the approach of watchful waiting, when must you follow up?
48-72 hours
up to 1/3 will need abx
What is first line therapy in AOM in pediatrics?
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
What is the only antibiotic for which IgE mediated testing is available?
penecillians and nothing else!
negative skin test 97-99% negative predictive value
When does a child need ENT referral for tympanostomy tubes?
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
what is the most common pediatric infectious disease?
viral rhinitis
what is the average progression of viral rhinitis?
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
what disorder that is common in adults is not common in children?
sinusitis
sinuses not completely developed until 20 years of age
what is a PE sign of allergic rhinitis in a child?
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)
what can be a dangerous drug to give for allergic rhinitis?
benadryl - or any 1st gen. antihistamines
What do you use to grade size of tonsils?
Broadsky Grading Scale or measurement of distance between tonsilar pillars
should you do a direct exam to confirm a diagnosis of epligotitis?
No, unless you are an airway expert and are ready to intubate the pediatric patient in laryngospasm
penlight test findings
cover-uncover test
At what age should you refer a child with strabismus to ophthalmology?
>4 months
what is chemical conjunctivitis?
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
what’s the treatment for neisseria opthalmicus?
ceftriaxone
ophthalmology referral
screen and treat parents
what is the presentation of chlamydia ophthalmia?
4-19 days of age
mild swelling of the lids and conjuctivae
hyperemia
scant purulent discharge
*can develop pneumonitis
what’s the treatment for chlamydia?
erythromycin
treat empirically for gonorrhea co-infection
screen and treat parents
what is the presentation of HSV ophthalmia?
typically unilateral
within 2-4 weeks of life
vesicular lid lesions
*corneal disease can threaten vision
what is the treatment for HSV ophthalmia?
acyclovir
what is the most common cause of tearing in children?
dacryostenosis
(nasolacrimal duct obstruction)
20% of newborns
6% of children in 1st year
what is the management of dacryostenosis?
non-surgical observation
lacrimal sac massage may help
refer to ophtho if not resolved by six months
what is the treatment of otorrhea in children with tympanostomy tuves
only FDA approved: fluroquinolone drops (cipro and ofloxacin)
when should you refer a child for tympanostomy tubes who has otitis media with effusion
if no resolution in 3 months
what does the diagnosis of sinusitis in a pediatric patient require?
- 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
what’s the presentation of mono?
tonsillar exudates
cervical lymphadenopathy (posterior chian)
fever
+/- spleen enlargement
what do you have to watch with hand, foot, and mouth?
coxasackievirus
hydration status
what’s the tell-tale sign of hand, foot and mouth?
ulcerations in posterior pharynx surrounded by a halo
what’s the presentation of strep throat?
fever, sore throat
tender cervical lymphadenopathy
erythematous posterior pharynx
+/- exudate and petechiae
N/V, headache
young children may have nasal congestion
what’s the Centor 4 point scale to diagnose strep throat?
fever
absence of cough
anterior cervical adenopathy
tonsilar exudates
what are two signs of scarlet fever?
strawberry tongue
scarlantiform rash on trunk
why do we treat strep?
prevent abscesses
acute glomerulonephritis
rheumatic fever
and PANDAS
what are the Paradise criteria for tonsillectomy?
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
what is the treatment for epiglotitis?
IV ceftriaxone or cephalosporin
endotracheal intubation - extubation 24-48 hours after reduction in swelling
what’s the treatment for severe cases of croup?
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
what is the causative organism of croup?
parainfluenza types 1 and 2
1 peaks every other autumn
2 has annual peaks
direct contact, fomites, droplets
what’s the epi of croup?
6 to 36 months of age biggest group
rare beyond 6 years
how do you treat a perforated TM?
oflaxacin or cipro drops
