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Senoir 21-2 > PEDS ENT > Flashcards

PEDS ENT Flashcards

1
Q

Opto vs Opthomology

A

Optometrist is an eye doctor that can examine, diagnose, and treat eye problems

An ophthalmologist is a medical doctor who can perform medical and surgical interventions for eye conditions

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2
Q

What is the visual acuity of newborns

A

Visual acuity in newborns ~ 20/400

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3
Q

How do you assess vision in children

A

Infants: regard for the parent’s face, feeding most evident

2 wks old: more sustained interest in large objects

8-10 wks old: can follow an object 180 degrees

Term: Fix and Follow

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4
Q

When is the onset of proper eye coordination

A

About 3-4 months

Refer to Ophthalmology at 4 months if dysconjugate gaze persists

Refer at 6 months if strabismus persists

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5
Q

When should you refer a child for persisting strabismus

A

6 months

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6
Q

When should you refer for persistent dysconjugate gaze

A

4 months

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7
Q

What reflex in the eye should be checked in all peds pts

A

Red eye reflex

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8
Q

How do you assess visual acuity in peds

A

Electronic vision screeners: 6 months and above

Age 3-5 years: shape chart

> 5 years: try Snellen chart

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9
Q

At what age should visual acuity reach 20/20

A

6yo

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10
Q

What is the most common cause of visual impairment in peds

A

retinopathy of prematurity

Legal blindness: visual acuity 20/200 or worse

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11
Q

What is the critical line for NML visual acuity in peds

A

Age (years)/Rule of 8s /”Critical line” for normal visual acuity

Example:

2 2 + 6 = 8 20/60
3 3 + 5 = 8 20/50

“If it equals eight, vision is great! Nine or more, vision is poor.”

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12
Q

Hyperopia vs Myopia

A

Hyperopia—farsightedness
(cannot see things close)
Infants: hyperopic at birth

Myopia-nearsightedness
(cannot see things far away)
Blurred vision for distant objects
Infrequent in infants and pre-school children, unless preemies (ROP)

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13
Q

Eso, eso and hyper strabismus

A 
Nasal = “eso”
Temporal = “exo” (exiting out)
Superior = “hyper” (much less common)
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14
Q

Define tropia

A

Constant strabismus

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15
Q

What is latent strabismus or phobia

A

Strabismus Only when visual fixation of the affected (non-dominant) eye is interrupted = latent strabismus = “phoria”

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16
Q

Define amblyopia

A

Amblyopia

Unilateral or bilateral central vision loss due to inappropriate visual development

3 types of amblyopia:
Strabismic
Refractive
Deprivation

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17
Q

What are the types of deprivation amblyopia

A

Retinopathy of prematurity (ROP)

Congenital cataracts/glaucoma

Retinoblastoma
-Usually presents w/ leukocoria

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18
Q

How do you determine pseudostabismus

A

(looks like eyes are not aligned straight but they really are)

will have normal corneal light reflex

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19
Q

What is the normal and late onset of esotropia

A

Can be congenital

Needs surgical correction

Onset between 2-5 yo

  • Often due to refractive error
  • Requires patching/glasses

Late onset (after 5 yo) may signify CNS disease (tumors, etc.)

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20
Q

What is the onset and tx fro exo tropia

A

Onset around 2 yo

Treatment options:
Observation
(for mild cases & self correcting)

Patching/glasses
(for persistent cases)

Surgical correction 
(for extreme cases)
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21
Q

How to do the cover and cover/uncover test

A

Cover test (strabismus)
(confirms which eye is affected):
-Misalignment that is present on simple observation

Cover affected eye, normal eye does NOT move
Cover normal eye, affected eye moves
Moves opposite direction of deviation*

Cover/uncover test:
-May reveal a slight or latent muscle imbalance not otherwise seen

Cover “bad” eye & it deviates from fixation; it swings back to midline when uncovered

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22
Q

Absence of a red reflex what is the DDX

A

Leukocoria (white reflex): can be indicative of the following-

  • Cataracts
  • Ocular tumors (e.g., retinoblastoma)
  • Severe chorioretinitis
  • Retinopathy of prematurity
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23
Q

A child with poor school performance should get what w/u

A

rule out/in vision problems

Also ears

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24
Q

Any child w/ a visual acuity worse than 20/40 in either eye after 4 yo or 2 line difference on eye chart between eyes
….

A

REFER To optho

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25
What are the 4 types of conjunctivitis
Neonatal Infectious Allergic Chemical
26
Conjunctivitis on day 2-7 Think what agent
N. gonorrhoeae, Staphylococcus, Streptococcus, Pseudomonas, E. coli
27
Conjunctivitis on day 4-19 post birth Think what agent
Chlamydia
28
Dendritic lesions on the cornea Think
HSV
29
What is the Rx for gonococal infection prevention in the eyes
erythromycin 0.5% ointment after birth
30
Tx for Conjunctivitis Gonorrhea
Ceftriaxone single dose (25-50 mg/kg) IV or IM Hospitalize (irrigation intense!)
31
Tx for Chlamydia Conjunctivitis
Erythromycin PO x 14 days
32
Tx for pseudomonas conjunctivitis
Systemic abx (gentamycin IV), local saline irrigation, gentamycin ointment
33
Tx for S. Aureus Conjunctivitis
erythromycin or polysporin
34
What is the main virus causing conjunctivitis
Adenovirus
35
Conjunctivitis with a pre auricular lymphnode Think
Adenovirus (viral )
36
MGMT for Viral Conj
Supportive treatment & infection control (hand washing) Cool compresses recommended over warm (increases swelling) Overtreatment (treatment w/ antibiotic drops/ointment) is common & often excusable due to diagnostic challenges
37
Tx options for bacterial conjunctivitis
H. influenzae, S. pneumoniae, M. Catarrhalis are the most common agents Treat wtih: Topical antibiotics work well: erythromycin, polytrim
38
ABX to use in the eyes for children over 1
Polytrim drops
39
ABX to use in the eyes in peds under 1
Erythromycin ophthalmic ointment
40
Conjunctivitis that is pruritic and bilateral Think
Allergic
41
Tx for allergic conj
Topical vasoconstrictors, NSAIDs & antihistamines Topical cromolyn Nasal steroids can help concurrent eye symptoms Systemic antihistamines less effective for eye
42
If a pt presents with ciliary flush (Injections around the limbus) What is the next step
SAME DAY referral
43
A child presents with photophobia, burning/ irritation of the eyes, that causes rubbing of the eyes Agent is staph Think
Blepharitis of the eye lid margin staphylococcal infection + seborrhea + meibomian gland dysfunction TX: Initial: eyelid hygiene w/ eyelid scrub (i.e., gentle cleansing w/ baby shampoo—tear free!) Warm compresses & topical antibiotics
44
1st line tx for Dacryostenosis
Duct massage
45
What is the treatment for severe dacrocystitis
Oral ABX -> if no improvement x 24-48hours -> refer to optho
46
What is the tx for dacryocysitis
If uncomplicated is nasolacrimal massage 2-3 x/day Cleanse lids with warm water Topical abx if mucopurulent drainage Bland ophthalmic ointment on eyelids If severe dacroystitis: oral abx
47
DDX for Hordeolum vs chalazion
Hordeolum: Tender and erythematous Chalazion : non tender
48
Tx for Hordeolum
Warm compresses -15 min 4-6x a day NSAIDS If no improvement/resolution in 1-2 wks: Ophthalmology for I&D
49
Tx for Chalazion
If small → spontaneous resolution in weeks to months Warm compress No resolution/symptomatic → Ophthalmology for steroid injection or surgical removal
50
DDX for periorbital vs orbital cellulitis
No proptosis or ophthalmoplegia (pain with eye movement)
51
Agent causes of periorbital cellulitis
S. aureus!!, pneumococcus or group A streptococcus
52
MGMT for periorbital cellulitis
Management: Outpatient treatment (CT scan not needed) -As long as child non-toxic appearing Treatment: Oral cephalexin, clindamycin or amoxicillin/clavulanate MRSA concern: trimethoprim-sulfamethoxazole (Bactrim) or clindamycin Follow daily!
53
What are the main agents of Orbital Cellullitis
Causes: S. aureus!, S. pneumoniae!, other streptococci, H. influenza
54
MGMT for orbital cellulitis
Hospitalization!! Obtain blood cultures to guide therapy Broad spectrum IV antibiotics: MRSA + S. pneumonia + gram negative bacilli coverage -vancomycin + cefotaxime or ceftriaxone Ophthalmology referral ``` CT scan (determines need for surgical intervention) ``` ->Surgical drainage if indicated
55
What is otalgia and otorrhea
Otalgia = acute ear pain Otorrhea = ear drainage
56
What is otitis media with effusion
Collection of non-infected fluid in middle ear space Other names: serous OM or secretory OM Most often seen with concurrent URI or pharyngitis
57
What is middle ear effusion
presence of fluid in middle ear space Often residual from recent AOM Can take 3 months to clear Can result in conductive hearing loss (CHL)
58
What is the age most at risk for OM
Under age 2
59
MC causes of AOM
Bacterial (most common): S. pneumoniae, H. influenzae, M. catarrhalis, group A streptococcus Viral (<20%): rhinovirus, influenza, RSV (VIRAL MORE RARE)
60
Criteria to Dx AOM
Presence of following 3 things: - Acute onset of signs/symptoms - Middle ear effusion - Middle ear inflammation
61
Tx/ MGMT for AOM
1st Treat Pain! All are treated with ABX (Amoxicillin Po) (Ceftriaxone IV or IM) Unless Older than 2 years with bilateral AOM without otorrhea can observe Or Any age that is unilateral without otorrhea
62
When should peds get ear tubes places for AOM
Children w/ developmental risks OR recurrent AOM + 3 mos persistent effusion w/ bilateral hearing loss Refer to ENT for pressure equalization tubes (PET) insertion*
63
What is the typical resolution of persistent middle ear effusions
May last weeks to months Usually resolves in 3 months Regular evaluation for persistent effusion at every well-child exam -Associated w/ conductive hearing loss (mild to moderate & transient or fluctuating) Leads to speech delay
64
What is the MGMT approach to Reccurent Otitits media
If recurrent <1 month since tx, ->change antibiotic -Suspect resistant bacteria If recurrent >1 month, may use ->same antibiotic -Suspect separate infections ``` If >3 episodes in 6 months OR if >4 episodes in 12 months OR persistent OME for >3 months: ->ENT referral: eval for PE tubes ```
65
Step I-4 ABX for AOM
Amoxicillin - > amoxicillin/ clav - > Cefuroxime - > IM ceftriaxone
66
What is swimmers ear
otitis externa
67
A peds presents with ear pain, tenderness, and discharge with a tender pinna on manipulation Suspect
Otitis externa See: Tenderness at tragus & w/ chewing Auditory canal: erythema & edema Discharge (scant to copious) TM typically unaffected
68
Tx for Otitis externa
Pain meds: NSAIDS and ASA Topical ABX: Ofloxacin or ciprofloxacin w/ hydrocortisone or dexamethasone Fluoroquinolones safe for tympanostomy tubes (not ototoxic) Polymyxin B-neosporin-hydrocortisone
69
Most common site for epistaxis
90% from anterior nose (Kiesselbach’s plexus) due to dry, friable mucosa
70
If a nose bleed persists beyond 10 minutes of pressure What are the next steps
Afrin -> Referal to ENT if still unresolved If the bleeding is posterior -> ENT referal (Avoid sepal necrosis)
71
What bacterial agent is common in epistaxis recurrence
S. Aureus Tx with Mupirocin
72
Most common cause of the common cold
Rhinovirus
73
What is the most common complication of the common cold in peds
Otitis media
74
What is the age limit in peds to use Anithistamines and decongestants
Antihistamines & decongestants → not in children <6yo (due to adverse effects & lack of benefits)
75
Should cough suppressants or expectorants be used in peds for the common cold
NO!
76
What sinuses are present at birth
Maxillary & Ethmoid sinuses
77
When do the sphenoid sinuses develop
Age 5
78
When dot eh frontal sinuses develop age 7
79
What are the ostia of the sinuses
Openings that drain sinuses Narrow : 1-3mm Drain into the middle meatus (ostiomeatal complex)
80
What is the criteria to Dx sinusitis
Physical findings lasting >10-14 days w/out improvement or increased severity compared to common cold Most common: mucopurulent rhinorrhea, nasal stuffiness, cough (esp., at night) Other si/sx: Nasal quality to voice, halitosis, facial swelling, facial tenderness/pain, headache Lab/Rad—usually not needed
81
WHat ist he 1st line Tx for Sinusitis
amoxicillin-clavulanate x10-14 days -High-dose therapy (80-90 mg/kg): -high risk for resistant bacteria: ``` Penicillin allergy: -Levofloxacin (type 1 hypersensitivity) -Clindamycin + 3rd generation cephalosporin (cefixime, cefpodoxime) (non-type 1 hypersensitivity) ``` >50% recover w/out any antimicrobial therapy
82
What are the risk factors for resisting bacteria in sinusitis
Antibiotics in preceding 1-3 months Age <2yrs High rates of local antimicrobial resistance
83
What is hay fever
Allergic rhinitis (seasonal or perineal) Sneezing, itching, rhinorrhea, & congestion NO FEVER!! (If fever think infectious etiology)
84
What are the early and late phase allergic rhinitis
IgE-mediated allergic response Early phase ->Mast cells degranulate → release histamine & tryptase, leukotrienes, prostaglandins, & platelet-activating factor Late phase (4-8 hrs later) - Eosinophils, basophils, CD4 T cells, monocytes, & neutrophils release chemical mediators - >chronic nasal inflammation & platelet-activating factor
85
What is the atopic triad
Eczema + asthma + allergic rhinitis
86
What is rhinitis medicamentosa
overuse of topical nasal decongestants (oxymetazoline, phenylephrine, or cocaine) seen more in adolescent
87
Suspect ______w/ hx of unilateral, purulent nasal discharge or foul odor
Foreign bodies
88
What is the 1st line Tx for Allerigic Rhinitis
Intranasal corticosteroids | 2nd line: oral antihistamines Cetirizine
89
When is Montelukast best to use in sinusitis pts
best in concomitant asthma
90
What is the most common cause of pharyngitis
Viral viral viral and viral
91
What is the only bacteria that is tested for in pharyngitis
Strep
92
What is the most important clinical finding in Group A strep pharyngitis
Sore throat+ fever+ NO COUGH!
93
What is the modified CENTOR criteria
- Absence of cough - Tender/swollen anterior cervical adenopathy - Fever of >100.4F - Tonsillar swelling or exudates - Age 3-14 yo (however, if ≥45 yo then -1 point) Interpretation: 0: strep unlikely, treat as viral (i.e., no antibiotics) 1-3: culture or rapid strep test & antibiotics if positive 4-5: probable strep, rapid test or culture Can consider empiric antibiotics but frowned upon if rapid available
94
What is the clinical manifestations of Group A strep pharyngitis
*  Sudden onset of sore throat *  Age 5-15 yr *  Fever *  Headache *  Nausea, vomiting, abdominal pain *  Tonsillopharyngeal inflammation *  Patchy tonsillopharyngeal exudates *  Palatal petechiae *  Anterior cervical adenitis (tender nodes) *  Winter and early spring presentation *  History of exposure to strep pharyngitis *  Scarlatiniform rash
95
What are the clinical manifestations of Viral Pharyngitis
*  Conjunctivitis *  Coryza *  Cough *  Diarrhea *  Hoarseness *  Discrete ulcerative stomatitis *  Viral exanthema
96
What is the gold standard testing for pharyngitis and tonsillitis
Strep culture (swab) if suspected Gold standard Takes 24-48 hours to get result
97
CAn you throat swab for mono
If mononucleosis is in differential diagnosis → monospot (highly specific & sensitive) & CBC w/ differential—blood test, not a swab
98
What is the tx for GAS pharyngitis
Amoxicillin 50mg/kg QD x 10 days (low dose) 2*: Oral Penicillin V 10mg/kg/dose bid-tid x10 days 3* Benzathine penicillin G IM (single dose) (compliance issues)
99
Does prevention of rheumatic fever in pharyngitis prevent post strep Glomerulonephritis?
NO
100
What does PANDAS stand for in Pharyngitis
Pediatric autoimmune neuropsychiatric disorders associated w/ streptococcal (PANDAS) infection → basal ganglia inflammation S/s :OCD, tics (motor and/or vocal)

Senoir 21-2 (77 decks)

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