peds - EENT pearls

Question 1

What is required for the clinical dx of AOM?

Answer 1

The clinical diagnosis of AOM requires:
1) bulging of the tympanic membrane or
2) other signs of acute inflammation (eg, marked erythema of the tympanic membrane, fever, ear pain) and middle ear effusion

Question 2

acute vs chronic AOM

Answer 2

Acute: < 3 weeks,
chronic: >3 mo
recurrent: 3 episodes in 6 mo or 4 in 12 with clearing between

Chronic >3 mo: clear serous fluid in the middle ear without s/sx of ear infection (may have hearing loss / asymptomatic) – no abx

Question 2

what are key findings of otoscopic exam for AOM

Answer 2

bulging of the TM and limited mobility of the TM with pneumotoscopy

Question 3

tx of AOM

Answer 3

1st line = amoxicillin

Treat < 2 y for 10 days and > 2 y for 5-7 days
Recurrent: tympanostomy, tympanocentesis, myringotomy

Question 4

what is the most common cause of pharngitis?

Answer 4

viral - adenovirus (MCC), rhinovirus, enterovirus, EBV, RSV, influenza

Question 5

what clinical features are associated with viral pharyngitis?

Answer 5

cough, hoarsness, coryza, conjunctivitis, diarrhea, fever

Sore throat, pain or swallowing and may have phonation

Question 6

test for EBV

Answer 6

heterophile agglutination test, atypical lyphocytes

Question 7

cause of bacterial pharyngotonsillitis

Answer 7

Group A strep

Question 8

clinical features of bacterial pharyngotonsillitis?

Answer 8

dysphagia, fever

on exam: pharynggeal edema/exudate, tonsillar exudate and petichiae, anterior cervical adenopathy

Question 9

what is Centor criteria?

Answer 9

GABHS-suggestive manifestations: fever 100.4+, tender anterior cervical lymphadenopathy, lack of cough,
pharyngotonsillar exudate

Question 10

what is the first line treatment of strep throat?

Answer 10

Penicillen (PCN G or VK, amoxicillin)

macrolides, clinda, chephalosporins if PCN allergy

Question 11

complications of strep throat?

Answer 11

rheumatic fever if left untreated

glomerularnephritis or peritonsillar abscess

Question 12

what type of pharyngitis is common in patients usuing inhaled steroids?

Answer 12

fungal

Question 13

likely dx in a patient with GAS infection presenting with diffuse skin eruption (sandpaper texture), circumoral pallor, and strawberry tounge

Answer 13

Scarlet fever

Question 14

clinical manifestations of allergic rhinitis

Answer 14

sneezing, nasal congestion, itching, clear, watery rhinorrhea

boggy turbinates, nasal polyps w/ cobblestone mucosa,** allergic shiners** (edematous, dark circles under
eyes) & allergic salute (transverse nasal crease from pushing up on the nose)

Question 15

1st line management of allergic rhinitis

Answer 15

intranasal corticosteroid

Question 16

MCC of epiglottitis?

Answer 16

HiB

Question 17

classic clinical presentation of epiglottitis?

Answer 17

• 3 D’s - **drooling, dysphagia, distress **
• Fever, odynophagia, inspiratory stridor, dyspnea, hoarseness, muffled “hot potato” voice, restlessness
• Tripod/Sniffing dog position: leaning forward, elbow on lap, neck hyperextended, chin protruding

Question 18

diagnostic findings of epiglottitis?

Answer 18

definitive dx: larygoscopy (cherry-red epiglottis w/ swelling)

xray - thumbprint sign

Question 19

Management and prevention of epiglottitis

Answer 19

maintain airway
abx: 2nd or 3rd gen cephalosporin (ceftriaxone, cefotaxime)

prevention: rifampin to close contacts; vaccine!!

Question 20

MCC of bacterial vs viral conjunctivitis

Answer 20

bacterial: S. aureus, strep pneumo, M. cat, H. flu

viral: adenovirus

Question 21

how do the presentation of bacterial vs viral vs allergic conjunctivitis differ?

Answer 21

bacterial: eye crusting (“stuck shut in morning”), purulent discharge; unilateral

viral: foreign body/gritty sensation, starts unilateral and progresses bilateral 1-2 days, viral sx

allergic: bilateral, conjunctival erythema, allergy sx