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Clinical Medicine Lecture - Professor Kramer > Pediatrics: Review of Eye, Ears, Nose, Throat and Respiratory Disorders > Flashcards

Pediatrics: Review of Eye, Ears, Nose, Throat and Respiratory Disorders Flashcards

1
Q

Blepharitis tx ?

A

Gentle lid scrubs

Warm compresses

Ophthalmic antibiotic ointment
Erythromycin OR
Bacitracin

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2
Q

Hordeolum tx ?

A

Gentle lid scrubs

Warm compresses

Ophthalmic antibiotic ointment
Erythromycin OR
Bacitracin

consider - I/D

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3
Q

Chalazion tx ?

A

Gentle lid scrubs

Warm compresses

Ophthalmic antibiotic ointment
Erythromycin OR
Bacitracin

consider - I/D

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4
Q

Allergic conjunctivitis sxs ?

A 
Lacrimation
Sneezing
Cobblestoning 
Stringy discharge
Pruritus
Rhinorrhea
ass. UR allergies as well
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5
Q

Allergic conjunctivitis tx. ?

A

remove source

Ophthalmic antihistamines (olaptadine)

Ophthalmic mast cell stabilizers (ketotifen)

Ophthalmic NSAID (ketorolac)

corticosteroids (prednisolone)

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6
Q

Ophthalmic antihistamines ?

A

olaptadine

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7
Q

Ophthalmic mast cell stabilizers ?

A

ketotifen

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8
Q

Ophthalmic NSAID ?

A

ketorolac

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9
Q

Viral conjunctivitis sxs. ?

A

Watery discharge

Preauricular lymphadenopathy

URI symptoms

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10
Q

Viral conjunctivitis herepes sxs. ?

A

Vesicular rash

Keratitis– corneal involvement
Visual disturbance

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11
Q

Viral conjunctivitis tx. ?

A

Supportive

Hand washing! - cause they are contagious

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12
Q

Viral conjunctivitis herepes tx. ?

A

Ophthalmic trifluridine OR

Oral acyclovir

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13
Q

Bacterial conjunctivitis tx ?

A

Ophthalmic antibiotics

Macrolide (erythromycin)

Aminoglycoside (gentamicin)

Sulfacetamide

Polymixin-bacitracin

If due to pseudomonas
Fluoroquinolone (ofloxacin)

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14
Q

Periorbital cellulitis ?

A

Warm compresses

Oral antibiotics - Augmentin

keep eye on they as out patient

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15
Q

Orbital cellulitis ?

A

IV antibiotics - Unasyn

Ophthalmology STAT referral

admit

Consider adding
Clindamycin
Metronidazole

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16
Q

Amblyopia tx ?

A

Earlier treatment improves outcome

Refractive– glasses

Cataracts– early removal

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17
Q

Amblyopia unilateral tx. ?

A

Make correction early

Patch dominant eye

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18
Q

Strabismus tx. ?

A

Congenital– surgery
cataracts then remove then and male the EOM intoaligment

Accommodative– glasses

Unilateral
Patch dominant eye

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19
Q

Retinoblastoma tx. ?

A

Chemoreduction

Then local options

  • laser photocoagulation
  • cryotherapy
  • plaque radiotherapy
  • thermotherapy
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20
Q

Otitis externa pathogens ?

A

Staph aureus

Pseudomonas aeruginosa

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21
Q

Otitis externa tx. ?

A

Remove debris if present ( for drops to be absorbed better)

Otic antibiotics

  • Fluoroquinolones (ciprofloxacin, ofloxacin)
  • –With or without hydrocortisone

Consider

Neomycin, bacitracin, polymyxin B and hydrocortisone (Cortisporin)

If complicated (perichondritis/ fever)
Oral quinolone (ciprofloxacin)
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22
Q

Acute Otitis Media (AOM) pathogens ?

A

Strep pneumoniae

Haemophilus influenzae

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23
Q

Otitis media tx. ?

A

Amoxicillin

If failure in 48-72 hrs
Amoxicillin-clavulanate OR
Cephalosporins (cefuroxime, cefdinir)

Observation option
Watch 48-72 hours for improvement

If recurrent
Tympanostomy tubes ( refer to ENT )
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24
Q

Mastoiditis tx. ?

A

piperacillin/tazobactam

Surgical debridement if
Abscess
No improvement within 48 hours

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25
Q

Epistaxis tx. ?

A

Lean forward and hold nose 5 min

Consider

  • Vasoconstrictors (oxymetazoline)
  • Nasal saline twice daily - keep mucosa moist
  • Gelatin sponge (Gelfoam)
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26
Q

Nasal foreign body tx. ?

A

Nose blowing

Forceps removal

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27
Q

Allergic rhinitis tx. education ?

A

Remove source

Saline spray may irrigate

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28
Q

Allergic rhinitis tx. intranasal corticosteroids ?

A

Fluticasone

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29
Q

Allergic rhinitis tx. oral and intranasal antihistamines ?

A

Loratadine (Claritin) oral

Olopatadine (Patanase) nasal

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30
Q

Allergic rhinitis tx. leukotriene antagonists ?

A

Montelukast (Singulair)

31
Q

Allergic rhinitis tx. Decongestants ?

A

Guaifenesin

32
Q

Viral upper respiratory infection tx. ?

A

Pain medication
Humidified air
Nasal saline

Consider
Cough suppressants

33
Q

Bacterial sinusitis 1st line ?

A

Amoxicillin high dose (40 mg/kg is average, 90 mg/kg is high does) OR

Amoxicillin-clavulanate

SEVERE, if they in daycare or they have been on ABS for something els e

34
Q

Bacterial sinusitis 2nd line ?

A

Cephalosporin (cefuroxime, cefdinir)

Clindamycin

Levofloxacin

35
Q

Strep pharyngitis centor criteria ?

A

Fever

Tonsillar exudates

Tender anterior cervical lymphadenopathy

Absence of cough

in this case there is not testing

36
Q

Strep pharyngitis tx. 1st line ?

A

Penicillin VK oral OR

Benzathine penicillin IM 600,000 units OR

Amoxicillin oral

37
Q

Strep pharyngitis Tx if PCN allergic ?

A

Clindamycin

Cephalexin

Azithromycin

38
Q

Mononucleosis tx. ?

A

Supportive care

Avoid contact sports

39
Q

Epiglottitis
(Supraglottitis) tx. ?

A

AIRWAY FIRST!
Consider intubation
Do not delay for testing

Antibiotics
3rd generation cephalosporin (Ceftriaxone)

40
Q

Croup (Laryngeotracheobronchitis) tx. home ?

A

Steaming bathroom

Cold weather exposure

Oral hydration

41
Q

Croup (Laryngeotracheobronchitis) tx. mild ?

A

Humidified oxygen

42
Q

Croup (Laryngeotracheobronchitis) tx. more significant ?

A

Racemic epinephrine nebulized

Dexamethasone IM/ oral

43
Q

Croup (Laryngeotracheobronchitis) tx. severe or persistent ?

A

Consider heliox

Consider intubation

Admit to hospital

44
Q

Bacterial tracheitis
(pseudomembranous croup) tx. ?

A

Intubation

Debridement of airway
-with Suctioning

IV antibiotics

Need staph and h flu coverage

3rd generation cephalosporins (Ceftriaxone)

45
Q

Pertussis (Whooping cough) tx. prevention ?

A

DTaP immunizations

Herd immunity for infants

46
Q

Pertussis (Whooping cough) tx. ?

A

azithromycin

consider: CCS, nebulizer

47
Q

Laryngomalacia H and P ?

A

At birth or within the first few months of life.

Intermittent, high-pitched, inspiratory stridor.

Worse supine and with activity

48
Q

Laryngomalacia tx. ?

A

Mild
Observation

Moderate-Severe
Surgical epiglottoplasty

49
Q

Infant Respiratory Distress Syndrome
(Hyaline membrane disease)
 tx. ?

A

Prevention
-Maternal glucocorticoids

Exogenous surfactant
-Can initiate in delivery room

Synchronized mandatory ventilation

50
Q

Bronchopulmonary dysplasia tx. ?

A

Ventilation

Surfactant

51
Q

Asthma common sxs. ?

A

Wheezing
Expiratory
Higher pitch if worse

recurrent cough
shortness of breath
"chest congestion" 
prolonged cough
exercise intolerance
Dyspnea
52
Q

Asthma severe sxs. ?

A

No lung sounds
Nasal flaring
Accessory muscle use

53
Q

Asthma spirometry ?

A

Lower FEV1 and FEV1/FVC

Improvement with bronchodilator

54
Q

Asthma CXR ?

A

Nonspecific, unless additional pneumonia

Hyperinflation (flattening of the diaphragms), peribronchial thickening

55
Q

Bronchiolitis H and P ?

A 
Coughing
Tachypnea
Labored breathing
Hypoxia
Irritability
Poor feeding
Vomiting
Wheezing and crackles
56
Q

Bronchiolitis tx. ?

A

Suction
Supplemental oxygen
Hydration

57
Q

Bronchiolitis severe ?

58
Q

Bronchiolitis prevention ?

A

Palivizumab

59
Q

Cystic fibrosis H and P ?

A

Recurrent lung problems

Cough
With sputum

Infertility

Pancreatitis hx

Steatorrhea

Abd pain

Finger clubbing

Increased AP chest ( these kids are more 2:1)

Percussion hyperresonance
Nasal polyps

60
Q

Cystic fibrosis tx. ?

A

Clear secretions
Bronchodilators
Pancreatic enzymes replace

Consider as needed

  • Treat infections
  • Screen yearly for acid fast bacilli sputum (TB)
  • Lung transplant
61
Q

Foreign body of trachea or bronchi prevention ?

A

Avoid small toys with children

Careful with foods – grapes, carrot pieces

62
Q

Foreign body of trachea or bronchi acutely ?

A

Heimlich maneuver

Bronchoscopy

63
Q

Foreign body of trachea or bronchi PNA ?

A

IV antibiotics

64
Q

Foreign body aspiration patient education ?

A

Carefully watch children

Avoid small toys with children

65
Q

Foreign body aspiration acutely ?

A

Heimlich maneuver

66
Q

Foreign body aspiration if unable to remove ?

A

Bronchoscopy

67
Q

Foreign body aspiration gastric aspiration ?

A

Abx only if evidence of pneumonia (only 1/4th of cases)

Controversial on benefit of steroids

68
Q

Pneumonia H and P ?

A

Fever
Cough
Wheezing
Crackles

69
Q

PNA CXR typical ?

A

Lobar infiltrate (strep pneumo)

70
Q

PNA CXR atypical ?

A

Diffuse bilateral (mycoplasma)

71
Q

PNA typical tx. ?

A

Amoxicillin OR

Ceftriaxone

72
Q

PNA atypical tx. mycoplasma ?

A

Macrolide antibiotics (azithromycin)

73
Q

PNA atypical tx.

Clinical Medicine Lecture - Professor Kramer (28 decks)

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