Pediatrics --E1 Flashcards
Red reflex is performed to assess for
eye opacities (cataracts or corneal clouding) and retinal abnormalities (retinal detachment or retinoblastoma)
at what age should an infant should be able to track or visually follow a moving object with both eyes
3 months
what age do you start using the E chart or allen chart
3 years
how do you screen for strabismus on a 3mo?
corneal light reflex test
how do you screen for strabismus on a 6mo?
cover test
what red reflex response would necessitate a referral
asymmetry of the red reflex or partially obscured red reflex
what age should not have temperature checked by tympanic measurement?
<3mo
minimum age for acetaminophen administration and dosage
2mo
15mg/kg/dose q4hr
minimum age for ibuprofen administration and dosage
> 6mo
10mg/kg
which type of growth deficiency is caused by inadquate caloric intake, excessive loss of calories, or inability to use calories peripherally
Type 1
which type of growth deficiency is characterized by All 3 parameters of growth – head circumference, weight, and height – are lower than normal
Type 2
which type of growth deficiency is characterized by a preserved head circumference with weight being more depressed than height
Type 1
Purulent discharge of the eye
bacterial conjunctivitis
causes of watery discharge of the eye
- viral conjunctivitis/keratitis
- iritis
- corneal abrasions/foreign bodies
mucoid discharge from the eye
allergic conjunctivitis or nasolacrimal obstruction
yellow crusts around the eye, but the eye remains white
nasolacrimal obstruction
inequality of the refractive state between the two eyes
anisometropia
reduced vision caused by conditions affecting normal vision development
amblyopia
squinting to see far (pinhole effect)
myopia
when either the cornea or the crystalline lens is not perfectly spherical
astigmatism
what is the hirschberg test
corneal light reflex evaluation– which is performed by shining a penlight at the patient’s eyes, observing the reflections of each cornea, and estimating whether the lights appear to be positioned symmetrically
what is a normal finding of a red reflex test
light orange-yellow in lightly pigmented eyes or dark red in brown eyes
Dx: s/s
- sudden severe pain
- decreased vision s/t pain and tearing
- eyelid edema
- tearing
- injection of the conjunctiva
Corneal abrasion
corneal abrasion treatment
erythromycin ointment
Vertical corneal abrasions can be a sign of
foreign bodies under the eyelid so eyelid eversion should be performed
signs of perforating ocular injuries (3)
irregularly shaped pupil, shallow anterior chamber, hyphema or dark tissue showing through the white sclera
a chronic inflammatory disorder of the eyelid and ocular surface that can be sight-threatening
Blepharokeratoconjunctivitis
treatment for blepharitis/Blepharokeratoconjunctivitis
Erythromycin ointment
azithromycin drops
PO azithromycin
an aseptic, nontender eyelid nodule
chalazion
A painful red bump on the eyelid caused by an acute bacterial infection of eyelash hair follicle or meibomian glands
Hordeolum
__ presents as a bluish mass located below the medial canthus
congenital dacrocystocele
Dx: S/S
- inflammation, swelling, tenderness, and pain over the lacrimal sac
- Fever may be present
- Purulent discharge within the lacrimal sac may reflux with sac pressure
Dacrocystitis
DX: s/s
redness, discharge and swelling of the lids and conjunctiva in an infant <1mo
Ophthalmia Neonatorum
Prevention of Ophthalmia Neonatorum
Erythromycin ointment
treatment of bacterial conjunctivitis
polymyxin/trimethoprim sulfate or fluroquinolones
DX: s/s
-conjunctival injection of one or both eyes (blood shot eyes)
- significant eyelid edema can occur
- Enlarged preauricular lymph nodes can be present
Viral Conjunctivitis
Presumed adenoviral keratoconjunctivitis is considered contagious ___
10-21 days from the day of onset or as long as the eyes are red
how long must a child stay out of school with adenoviral keratoconjunctivitis
until the redness and tearing resolve
__ causes itching associated with redness, tearing, and papillary reaction of palpebral conjunctiva
Allergic conjunctivitis
DX: s/s
-intense tearing, itching, and stringy discharge
- cobblestone papillae on the tarsal conjunctiva
- horner-trantas dots (white accumulation of degenerated eosinophils and epithelial cells)
- Phlyctenules (nodular inflammation on conjunctiva or cornea)
- Sterile corneal ulcers (shield ulcers)
vernal keratoconjunctivitis
treatment of allergic conjunctivitis
Antihistamine and mast cell stabilizers
treatment of mucocutaneous disease
topical corticosteroids, cyclosporine, and antibiotcs
a developmental defect due to incomplete closure of the anterior embryonal fissure
iris coloboma
DX:
penlight exam revelas a keyhold shaped pupil
Iris coloboma
DX:
eye exam reveals little to no visible iris
Aniridia
iris appears pink
Albinism
The classic triad of symptoms in primary congenital glaucoma (PCG) includes
Epiphoria
photophobia
blepharospasm
Primary congenital glaucoma primary sign
Buphthalmos (occurs from elevated eye pressure that leads to enlargement of the globe due to low scleral rigidity of an infant eye)
sudden eye pain, redness, corneal clouding, and vision loss suggest …
possible pupillary block or angle closure glaucoma (URGENT REFERRAL)
Treatment of uveitis
corticosteroids or methotrexate
Patients with pars planitis may complain of
floaters and decreased vision
DX: Slit-lap exam:
anterior chamber cells and protein flare (fogginess) with an irregular shaped pupil
active anterior uveitis
treatment for intermediate uveitis
corticosteroids
Children with ___ may complain of blurred vision and have a white retinal lesion that appears like a “headlight in the fog” owing to the overlying vitritis.
ocular toxoplasmosis (posterior uveitis)
red reflex response seen with a cloudy cornea
decreased or absent
DX: on exam
white spot on the cornea with overlying epithelial defect that stains with fluorescein
corneal ulcer
Absence of asymmetry of a red reflex, leukocoria, poor fixation, strabismus, or nystagmus and requires an urgent referral
cataract
___ may result in decreased central or peripheral vision, decreased color vison, strabismus, and nystagmus
Poor optic nerve function
___ assess relative function of each optic nerve
Swinging flash light test
Normal and abnormal swinging flash light test
Abnormal: pupillary dilation
Normal: Pupillary constriction
optic nerve appears white with a feathered edge
Myelinization of the optic nerve
___ is a specific term used for optic nerve edema caused by elevated ICP
Papilledema
Papilledema treatment
treat idiopathic intracranial hypertension w/ acetazolamide, topiramate and furosemide
DX: S/S
- Decreased visual acuity
- Abnormal color vision (notably red color desaturation)
- Pain with eye movements
- Visual field deficits
Optic neuritis
what does the optic nerve look like with anterior optic nerve neuritits
edematous (papillitis)
what does the optic nerve look like with posterior optic neuritis?
normal despite signs of optic nerve dysfunction
Pain with eye movements, blurred or double vision, and proptosis (bulging of the eye) suggests
orbital cellulitis
DX: s/s
red and swollen eyelids, pain, and mild fever. Normal eye, eye movements, and vision.
preseptal cellulitis
DX: s/s
proptosis, eye movement restriction, decreased vision, and an APD. Eye appears red and chemotic.
ortbital cellulitis
treatment of preseptal and orbital cellulitis
oral antibiotics
an involuntary rhythmic oscillation of eyes. It may be unilateral or bilateral or be gaze dependent
nystagmus
infantile nystagmus is associated with
retinal disease
__ is defined as a difference of best-corrected visual acuity of two lines or more on an acuity chart between the two eyes
Amblyopia
misalignment of the eyes resulting in abnormal binocular interaction and amblyopia of the nondominant eye
strabismus
difference in refractive error between two eyes resulting in poor visual input in one eye
anisometropia
deviation of the eyes toward the nose and may involve one or both eyes
Esotropia
onset of esotropia in a child >5 eyars old should cause suspicion for ___
CNS disease
how do you determine esotropia from pseudostrabismus
corneal light reflex – the light reflex with not be centered in one or both eyes if strabismus is present
deviation of the eyes toward the ears
exotropia
how to diagnose exotropia
corneal light reflex, cover/uncover test
DX: S/S
- Acute onset of pain, aural fullness, decreased hearing and itching in the ear
- Symptoms peak within 3 days
- Pain with pinna or tragus manipulation
- Clear or purulent discharge
- Swelling and narrowing of external auditory canal
Acute otitis Externa
__ is a cellulitis of the soft tissue of the external auditory canal (EAC) which can extend to surrounding structures
otitis externa
spread of acute otitis externs to the skull base with resultant osteomyelitis
malignant otitis externs
acute otitis externa treatment without systemic symptoms
- fluoroquinolone drops or cipro/dexamethasone drops
acute otitis externa treatment with fever, cellulitits of the face/auricle, or tender periauricular/cervical lymphadenopathy
oral antibiotics
2 critical findings to establish dx of acute otitis media
bulging tympanic membrane and middle ear effusion
DX:
otoscopic findings:
Bulging TM, impaired visibility of ossicular landmarks, yellow or white effusion (pus), opacified and inflamed eardrum, and occasionally squamous exudate or bullae on the eardrum.
Acute otitis media
treatment for acute otitis media
amoxicillin 80-90mg/kg/day BID
treatment for acute otitis media with a child with a history of papular rash from PCN
oral cephalosporins (cefuroxime, cefpodoxime, or cefdinir)
treatment of tympanic membrane perforation
topical fluoroquinolone otic drops (ofloxacin and ciprofloxacin) with or without steroids
otitis media with effusion should not be treated with ___
antibiotics
failure of the ear canal to form
atresia
external ear that is small, collapsed, or only has an earlobe present
microtia
absent external ear
anotia
ears that protrude from the skull due to lack of proper folds
prominotia
tx for acute bacterial rhinosinusitis
amoxicillin or augmentin
tx for acute bacterial rhinosinusitis in patients with type 1 hypersensitivity to PCN
cefuroxime, cefpodoxime, or cefdinir
treatment for allergic rhinitis
- intranasal corticosteroids (budesonide, fluticasone)
- oral/intranasal antihistamines (benadryl/cetirizine)/Azelastine
- leukotriene antagonists (Montelukast)
- decongestants (pseudoephedrine)
inflammation in the oral cavity and can arise from infection, autoimmune disorders, drug reactions, and chemoradiation.
stomatitis
3mm ulcers surrounded by a halo found on the anterior tonsillar pillars, soft palate, and uvula
herpangina
treatment for Acute group A streptococcal pharyngitis
PO or IM PCN or amoxicillin
DX: S/S
Severe sore throat
Unilateral tonsillar swelling
Deviation of the uvula
Trismus (limited mouth opening)
peritonsillar cellulitis or abscess
how to evaluate for acute cervical adenitis
rapid GAS test & CBC
contraindications for tonsillectomy or adenoidectomy
cleft palate
bleeding disorder
acute tonsilits
how is supprurative parotitis diagnosed
expression of purulent material from stenson duct
___ to identify allergen-specific IgE is the most sensitive and specific test for inhalant allergies
Skin testing
tx of mild intermittent rhinitis
- oral and intranasal H1-antihistamines
- intranasal decongestants (phenylephrine or oxymetazoline)
(oral decongestants are not recommended for kids)
nasal corticosteroid examples
mometasone and fluticasone furoate (approved for >2)
fluticasone propionate (approved for >4)
Budesonide and triamcinolone (Approved for >6)
mast cell stabilizer examples
intranasal ipratropium or cromolyn
topic nasal decongestants examples
phenylephrine and oxymetazoline
clinical findings of an IgE-mediated reaction to a medication (6)
Pruritis
erythema
urticaria
angioedema
bronchospasm
anaphylaxis
how long does it take an IgE-mediated reaction to occur after a dose of medication
1hr
___ are the first line treatments for community acquired PNA and otitis media
amoxicillin and ampicillin
___ are good for treating
dog bites
tonsillar and parapharyngeal abscesss
orbital cellulitis
refractory sinusitis
otitis media
Augmentin or ampicillin/sulbactam
example of a first generation cephalosporin
cephalexin
3rd generation cephalosporin
cefdinir
4th generation cephalosporin
cefepime
ex of antimicrobials (sulfonamides)
trimethoprim/sulfamethoxazole
erythromycin/azithromycin/clarithromycin are resistant to ___
s pneumoniae
first line treatment for UTIs in children
cephalexin
__ is used to treat sinusitis, dental/oral/neck abscesses
clindamycin
examples of tetracyclines
doxycycline
minocycline
tigecycline
aminoglycoside examples
gentamicin
tobramycin
amikacin
streptomycin
___ is the prefered rifamycin in patients co-infected with HIV
Rifabutin
Examples of fluroquinolones
Norfloxacin
oflaxacin
ciprofloxacin
moxifloxaxin
gatifloxacin
