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Clin Med II - Exam 2 > Pediatric ENT > Flashcards

Pediatric ENT Flashcards

1
Q

cholesteatoma

A

trapped epithelial tissues grows beneath surface of tympanic membrane
white, cystic mass w/in or behind TM, pearly and irregularly shaped
progressive HL
needs to be surgically removed or will erode mastoid bone, ossicles, inner ear and potentially the cranium
can occur across the lifetime

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2
Q

HL prevention

A

prevent erythroblastosis fetalis, hyperbilirubinemia, congenital rubella
avoid ototoxic antibiotics like aminoglycosides when possible
avoid exposure to loud noise - earbuds, firecrackers, cap pistol shots

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3
Q

AOM overview

A

acute otitis media
suppurative infection of the middle ear cavity
most prevalent in kids btwn 6-24 mos of age
80% of kids with AOM get better w/o antibiotics

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4
Q

AOM pathogens - bacterial

A

streptococcus pneumoniae, morexella catarrhalis, haemophilus influenze, strep pyogenes (less common)

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5
Q

AOM pathogens - viral

A

respiratory syncytial virus, rhinovirus, influenza, adenovirus, parainfluenza virus
more common than bacteria

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6
Q

AOM risks

A

non-modifiable - down syndrome, craniofacial anomalies, kids eustachian tubes are more horizontal/ level than adults
modifiable- day care, second hand cigarette smoke, formula-fed infants with feeding position (formula perfect for growth and flows back into eustachian tube)

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7
Q

AOM presentation

A

follow URI by 1-7 days, presents with pain a/o irritability, fever, nasal congestion

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8
Q

AOM Dx requirements

A

recent, abrupt onset of illness
presence of middle ear fluid or effusion
s+s of middle ear inflammation

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9
Q

severe AOM

A

moderate+ otalgia OR
otalgia > 48 hrs OR
Temp > 102.2

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10
Q

AOM tx plan

A

tx all kids 6-23 mos w/ antibiotics

tx kids 2+ with antibiotics or observation with clear follow-up plan

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11
Q

AOM antibiotics

A

if no amoxicillin in past 30 days - give amoxicillin 80-90 mg/kg/day for 10 days
if high risk or recent amoxicillin or tx failure in 48-72 hrs,
give augmentin (amoxicillin-clavulanate), cefuroxime axetil, ceftriaxone

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12
Q

AOM follow up

A

fluid persist for 4-6 wks after AOM

NO prophylactic antibiotics to reduce AOM in kids w/ recurrent AOM

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13
Q

tympanostomy tubes

A 
3 episodes of AOM in 6 mos
4 episodes in 1 year w/ 1 in past 6 mos
serous fluid for > 12 wks
complicated AOM that could lead to meningitis, mastoiditis, etc
fall out in 2-6 mos naturally
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14
Q

AOM prevention

A

promote breast-feeding for 6 mos after birth
decrease exposure to passive tobacco smoke
avoid bottle propping
prevnar decreases deadly, difficult strains of AOM infecteion

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15
Q

otitis externa etiology/ s+s

A

inflammation of skin in ear canal from trauma
often caused by water trapped in canal from swimming in lakes or pools
pathogens - staphylococcus aureus, psuedomonas aeruginosa
symptoms - pain with external ear tugging

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16
Q

OE tx

A

combo - antibiotic + corticosteroid
- cortisporin otic, cipro HC, floxin otic (topical)
ear wicks used in severe cases to get meds in ear
manage pain

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17
Q

OE prevention

A

let canal heal
avoid q tips
try mack’s earplugs
homemade solution after swimming - 1 part rubbing alcohol to one part white vinegar ( dries canal + some bacteriostatic)

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18
Q

choanal atresia

A

congenital nasal obstruction
b/l or u/l
bony (90%) or membraneous
b/l - presents at delivery with severe respiratory distress and paradoxical cyanosis, emergent surgery with possible incubation needed
u/l - asymptomatic besides unilateral nasal discharge

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19
Q

paradoxical cyanosis

A

cyanosis relieved by crying and worse when at rest

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20
Q

epistaxis

A

common in winter
most commonly due to nose picking
can be caused by cocaine - septal defect (longtime use)

21
Q

epistaxis tx

A

digital pressure and no nose blowing
phenylephrine spray or silver nitrate cautery
may need nasal packing

22
Q

epistaxis prevention

A

humidity, lubrication, cut nails, discontinue irritants

r/o underlying bleeding disorder if sever/recurrent

23
Q

septal hematoma

A 
collection of blood in the septum
rare cause of epistaxis
can cause permanent septal defect, ruin septum
tx - immediate I&D
usually due to blow to the nose
24
Q

allergic rhinitis

A

inflammation of nasal and sinus passages
seasonal, perennial, episodic
sneezing, runny nose, congestion, itchy eyes
20-30% of all kids, 75% of those with asthma
important hx - Fhx, home, pets, smokers, seasonal “triggers”
PE - allergic shiners, allergic salute

25
Q

atopic triad

A

asthma/ allergy/ atopic dermatitis

26
Q

AR tx

A

remove offending agent - pets, smoke, dust, mold, insects - dust mites, cockroaches
oral:
OTC - loratadine, cetirizine, fexofenadine, diphenyhydramine
Rx - desloratadine, monteleukast
topical
steroids ( best if used regularly) - fluticasone, triamcinolone (nasocort - OTC), mometasone, budesonide
antihistamines - azelastine HCl

27
Q

Viral URI

A

common in any age esp, 6 mos - 6 years
7-10 days
nasal congestion, coryza, sneezing, mild conjunctivitis, sore throat, hoarseness, cough, fever for 2-3 days that is low grade
cure - rest, fluids, time, saline nasal drops, oral cough and cold meds - supportive care and do not shorten duration ( be careful with psuedophedrine with little kids)
NO antibiotics

28
Q

coryza

A

rhinitis

29
Q

psuedophedrin

A

not approved for kids < 4 yo (prefer not until 6)

side effects

30
Q

sinus formation

A

sphenoid forms by 5 yo
frontal - by 7-8 yo present, not complete until late adolescence
ethmoid, maxillary present at birth

31
Q

acute bacterial sinusitis (ABS)

A

consider if URI symptoms for 7-10 days w/ no signs of improvement
presents by following URI
symptoms - purulent nasal discharge, headache, foul breath, toothache, facial pain and fever at times

32
Q

ABS pathogens

A

s. pneumoniae, h. influenzae, m. catarrhalis

33
Q

diagnostic criteria of ABS

A

persistent illness for > 10 days w/o improvement
worsening course of illnes
sever onset - fever > 102/39 OR purulent nasal discharge for at least 3 days
DON’T image unless concerned for orbital or CNS complications (kids have growing bones!)

34
Q

ABS tx

A

antibiotic theraphy OR additional outpt abservation *3 days

  • amoxicillin 80-90 mg/kg/day w/ or w/o clavulanate for 10+ days
  • recurrent cases - tx for 21 days
35
Q

ENT foreign bodies

A

ear: pain, drainage, HL
nose: unilateral purulent rhinitis, persistent sinusitis, blocked nasal passage on exam
don’t blindly probe - remove only if visible with forceps, curette, foley

36
Q

cleft lip and palate etiology

A

1 in 1,000
M:F ratio is 3:2
risks - fetal exposure to alcohol, tobacco, certain drugs
sometimes associated w/ recognizable syndrome or genetic abnormalities

37
Q

cleft lip

A

failure of maxilary and medial nasal processes to fuse
anywhere from a small notch to a complete cleft that extends to base of nose
worry about feeding difficulties
correct at 2-10 weeks of life

38
Q

cleft palate

A

midline fissure of the palate incomplete
concern about speech difficulty, otits media
surgery: 6-18 months

39
Q

hand, foot and mouth disease

A

usually coxsackie A16 virus
under 5 yo
incubation 5-7 days usually late summer and fall
painful oral ulcers, low grade fever, gray-red vesicles on palms and soles
tx - supportive - fluid and pain relief

40
Q

pharyngitis

A

usually viral esp under 2 yo
bacterial more commonly group a strep
identify and treat - reduce symptoms, prevent acute rheumatic fever development, prevent local suppurative complications, prevent transmission

41
Q

viral vs. group A strep

A

viral - gradual onset, sore throat, rhinorrhea, cough, and conjunctivitis, sometimes laryngitis, diarrhea, or fever
bacterial - sore throat, headache, fever, nausea, tonsillar exudates, petechiae on soft palate, beefy red throat, sandpaper rash over groing and torso - scarlet fever, has a fetted, sweet small

42
Q

strep diagnosis and tx

A

diagnosis: rapid strep antigen testing a/o throat culture, follow neg. with culture if sick <24 hrs
tx: penicillin or amoxicillin, erthyromycin if allergic

43
Q

tonsillectomy

A

documented sore throat-
1. 7+ episodes in 12 months
2. 5+ episodes in each of 2 prior years
3. 3+ episodes in each of 3 prior years
PLUS one of following: fever, tonsillar exudate, or positive culture
- if criteria not met, watchful waiting
- indicated for evidence of sleep-disordered breathing aND comorbid conditions that would benefit - growth retardation, poor school performance, enuresis, behavioral problems

44
Q

epiglottitis

A

usually group a strep
rapid onset of sore throat, muffled voice, high fever and drooling - kids look awful
thumb sign on x-ray
assume critical airway and don’t examine oropharynx unless able to intubate STAT

45
Q

mononucleosis

A

strep present in at least 25% of pts

ampicillin may cause a rash, don’t use, use macrolide

46
Q

peritonsillar abscess

A

unilateral walled of inside of tonsil, can get very large
more common 10+ yo
compl of group a strep pharyngitis
high fever, muffled voice, drooling, dyspnea, pain
tx - early diagnosis, I&D, antibiotic (hospitalization common)

47
Q

retropharyngeal abscess

A

posterior pharynx - cannot see
more common <6 yo
pathogens - staph aureus and anaerobes
high fever, muffled voice, drooling, toxic looking - look gray and worried
tx - early diagnosis, I&D, antibiotic (hospitalization common)

48
Q

cervical adenitis

A

inflammation of cervical lymph nodes via group A strep or staph aureus
symptoms - neck pain and dysphagia
signs - unilateral red, tender, swollen LN with fever
tx - PO, IM, IV antibiotic, strep test and possible PPD

Clin Med II - Exam 2 (4 decks)

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