Pediatric ENT

Question 1

Bacterial conjunctivitis

Answer 1

• purulent

- EEC, tetracycline, polymyxin B

Question 2

Gonococcal conjunctivitis

Answer 2

• must culture conjunctivitis

Question 3

Allergic conjunctivitis

Answer 3

• stringy, tearing
• oral antihistamines
• refer to allergist/ophth

Question 4

Viral conjunctivitis

Answer 4

• watery
• moderate: saline drops, antihistamines
• sulfacetamide 10 percent ophth solution for bacterial prophylaxis (Bleph 10)

Question 5

Herpetic conjunctivitis

Answer 5

• bright red and irritated

- refer to ophthalmologist

Question 6

When to refer strabismus?

Answer 6

fixed
≥ 6 months old
hypertropia and hypotropia

Question 7

Otitis externa (Swimmer’s ear)

Answer 7

• fungal: black specks, odor, treat with antifungal

- bacterial: acetic acid, cortisporin (neomycin, polymyxin B)

Question 8

Acute otitis media

Answer 8

• S. pneumoniae, H. influenzae
• Signs/symptoms: impaired TM mobility
• pain management (tylenol, benzocaine otic drops)
• watchful waiting 48 to 72 hours, then amoxicillin 80-90 mg/kg/day, BID for 10 days
• prevent with vaccines, avoid secondhand smoke

Question 9

Otitis media with effusion (OME)

Answer 9

• hearing loss, popping, pressure, air bubbles behind TM, decreased membrane mobility
• Tx: Watchful monitoring x3 months

Question 10

Which middle ear bone touches the umbro of the TM?

Answer 10

Stapes
Anvil
+++Malleus+++

Question 11

Assessment of conductive hearing loss

Answer 11

Weber: lateralizes to AFFECTED ear
Rinne: abnormal in affected ear (AC less than BC)

Question 12

Causative organisms of Pharyngitis/Tonsillitis

Answer 12

Viral: RSV, influenza, EBV
Bacterial: Group A beta hemolytic strep, gonorrhea

Question 13

Centor criteria

Answer 13

Fever (greater than 100.4F)
Lack of cough
Exudate
ANTERIOR cervical adenopathy

Question 14

Treatment of positive strep test

Answer 14

Pen VK 250mg PO TID x10 days

or if allergic, EEC 250mg PO QID x10 days

Question 15

Epiglottitis

Answer 15

• bacterial: S. pneumoniae, H. flu
• high fever, drooling, respiratory distress, “thumb sign” on x-ray
• Immediate hospitalization

Question 16

Croup

Answer 16

• viral infection of the larynx
• URI, barking cough, stridor, low grade fever, lungs clear
• “steeple sign” on x-ray
• treat mild cases as outpatient, supportive
• hospitalize severe cases, steroids and racemic epinephrine

Question 17

Mononucleosis (Epstein Barr Virus)

Answer 17

• fever, severe pharyngitis, malaise, POSTERIOR cervical adenopathy, tonsillar exudate, splenomegaly, may have rash
• diagnose with Monospot
• supportive treatment, avoid contact sports 3 weeks to several months to avoid splenic rupture

Question 18

Sinusitis (Rhinosinusitis)

Answer 18

• S. pneumoniae, H. influenzae, M. catarrhalis
• CT scan is preferred, culture
• augmentin x10 days, change to Levaquin if no improvement in 3 days (no quinolones in ≤ 9 years old)
• refer recurrent, chronic, or refractory sinusitis to ENT

Question 19

Assessment of sensorineural hearing loss

Answer 19

Weber: lateralizes to UNAFFECTED ear
Rinne: normal in affected ear (not a good test for this)