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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
Q

What are the 4 types of conjunctivitis

A

Neonatal

Infectious

Allergic

Chemical

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26
Q

Conjunctivitis on day 2-7

Think what agent

A

N. gonorrhoeae, Staphylococcus, Streptococcus, Pseudomonas, E. coli

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27
Q

Conjunctivitis on day 4-19 post birth

Think what agent

A

Chlamydia

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28
Q

Dendritic lesions on the cornea

Think

A

HSV

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29
Q

What is the Rx for gonococal infection prevention in the eyes

A

erythromycin 0.5% ointment after birth

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30
Q

Tx for Conjunctivitis Gonorrhea

A

Ceftriaxone single dose (25-50 mg/kg) IV or IM

Hospitalize (irrigation intense!)

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31
Q

Tx for Chlamydia Conjunctivitis

A

Erythromycin PO x 14 days

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32
Q

Tx for pseudomonas conjunctivitis

A

Systemic abx (gentamycin IV), local saline irrigation, gentamycin ointment

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33
Q

Tx for S. Aureus Conjunctivitis

A

erythromycin or polysporin

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34
Q

What is the main virus causing conjunctivitis

A

Adenovirus

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35
Q

Conjunctivitis with a pre auricular lymphnode

Think

A

Adenovirus (viral )

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36
Q

MGMT for Viral Conj

A

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

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37
Q

Tx options for bacterial conjunctivitis

A

H. influenzae, S. pneumoniae, M. Catarrhalis are the most common agents

Treat wtih:
Topical antibiotics work well: erythromycin, polytrim

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38
Q

ABX to use in the eyes for children over 1

A

Polytrim drops

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39
Q

ABX to use in the eyes in peds under 1

A

Erythromycin ophthalmic ointment

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40
Q

Conjunctivitis that is pruritic and bilateral

Think

A

Allergic

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41
Q

Tx for allergic conj

A

Topical vasoconstrictors, NSAIDs & antihistamines

Topical cromolyn

Nasal steroids can help concurrent eye symptoms

Systemic antihistamines less effective for eye

42
Q

If a pt presents with ciliary flush
(Injections around the limbus)

What is the next step

A

SAME DAY referral

43
Q

A child presents with photophobia, burning/ irritation of the eyes, that causes rubbing of the eyes

Agent is staph

Think

A

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
Q

1st line tx for Dacryostenosis

A

Duct massage

45
Q

What is the treatment for severe dacrocystitis

A

Oral ABX -> if no improvement x 24-48hours -> refer to optho

46
Q

What is the tx for dacryocysitis

A

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
Q

DDX for Hordeolum vs chalazion

A

Hordeolum: Tender and erythematous

Chalazion : non tender

48
Q

Tx for Hordeolum

A

Warm compresses
-15 min 4-6x a day

NSAIDS

If no improvement/resolution in 1-2 wks: Ophthalmology for I&D

49
Q

Tx for Chalazion

A

If small → spontaneous resolution in weeks to months

Warm compress

No resolution/symptomatic → Ophthalmology for steroid injection or surgical removal

50
Q

DDX for periorbital vs orbital cellulitis

A

No proptosis or ophthalmoplegia (pain with eye movement)

51
Q

Agent causes of periorbital cellulitis

A

S. aureus!!, pneumococcus or group A streptococcus

52
Q

MGMT for periorbital cellulitis

A

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
Q

What are the main agents of Orbital Cellullitis

A

Causes: S. aureus!, S. pneumoniae!, other streptococci, H. influenza

54
Q

MGMT for orbital cellulitis

A

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
Q

What is otalgia and otorrhea

A

Otalgia = acute ear pain

Otorrhea = ear drainage

56
Q

What is otitis media with effusion

A

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
Q

What is middle ear effusion

A

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
Q

What is the age most at risk for OM

A

Under age 2

59
Q

MC causes of AOM

A

Bacterial (most common):
S. pneumoniae, H. influenzae,
M. catarrhalis, group A streptococcus

Viral (<20%): rhinovirus, influenza, RSV
(VIRAL MORE RARE)

60
Q

Criteria to Dx AOM

A

Presence of following 3 things:

  • Acute onset of signs/symptoms
  • Middle ear effusion
  • Middle ear inflammation
61
Q

Tx/ MGMT for AOM

A

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
Q

When should peds get ear tubes places for AOM

A

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
Q

What is the typical resolution of persistent middle ear effusions

A

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
Q

What is the MGMT approach to Reccurent Otitits media

A

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
Q

Step I-4 ABX for AOM

A

Amoxicillin

  • > amoxicillin/ clav
  • > Cefuroxime
  • > IM ceftriaxone
66
Q

What is swimmers ear

A

otitis externa

67
Q

A peds presents with ear pain, tenderness, and discharge with a tender pinna on manipulation

Suspect

A

Otitis externa

See:

Tenderness at tragus & w/ chewing
Auditory canal: erythema & edema
Discharge (scant to copious)
TM typically unaffected

68
Q

Tx for Otitis externa

A

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
Q

Most common site for epistaxis

A

90% from anterior nose (Kiesselbach’s plexus) due to dry, friable mucosa

70
Q

If a nose bleed persists beyond 10 minutes of pressure

What are the next steps

A

Afrin -> Referal to ENT if still unresolved

If the bleeding is posterior
-> ENT referal (Avoid sepal necrosis)

71
Q

What bacterial agent is common in epistaxis recurrence

A

S. Aureus

Tx with Mupirocin

72
Q

Most common cause of the common cold

A

Rhinovirus

73
Q

What is the most common complication of the common cold in peds

A

Otitis media

74
Q

What is the age limit in peds to use Anithistamines and decongestants

A

Antihistamines & decongestants → not in children <6yo (due to adverse effects & lack of benefits)

75
Q

Should cough suppressants or expectorants be used in peds for the common cold

A

NO!

76
Q

What sinuses are present at birth

A

Maxillary & Ethmoid sinuses

77
Q

When do the sphenoid sinuses develop

A

Age 5

78
Q

When dot eh frontal sinuses develop age 7

A
79
Q

What are the ostia of the sinuses

A

Openings that drain sinuses
Narrow : 1-3mm
Drain into the middle meatus (ostiomeatal complex)

80
Q

What is the criteria to Dx sinusitis

A

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
Q

WHat ist he 1st line Tx for Sinusitis

A

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
Q

What are the risk factors for resisting bacteria in sinusitis

A

Antibiotics in preceding 1-3 months

Age <2yrs

High rates of local antimicrobial resistance

83
Q

What is hay fever

A

Allergic rhinitis (seasonal or perineal)

Sneezing, itching, rhinorrhea, & congestion

NO FEVER!!
(If fever think infectious etiology)

84
Q

What are the early and late phase allergic rhinitis

A

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
Q

What is the atopic triad

A

Eczema + asthma + allergic rhinitis

86
Q

What is rhinitis medicamentosa

A

overuse of topical nasal decongestants (oxymetazoline, phenylephrine, or cocaine)
seen more in adolescent

87
Q

Suspect ______w/ hx of unilateral, purulent nasal discharge or foul odor

A

Foreign bodies

88
Q

What is the 1st line Tx for Allerigic Rhinitis

A

Intranasal corticosteroids

2nd line: oral antihistamines
Cetirizine

89
Q

When is Montelukast best to use in sinusitis pts

A

best in concomitant asthma

90
Q

What is the most common cause of pharyngitis

A

Viral viral viral and viral

91
Q

What is the only bacteria that is tested for in pharyngitis

A

Strep

92
Q

What is the most important clinical finding in Group A strep pharyngitis

A

Sore throat+ fever+ NO COUGH!

93
Q

What is the modified CENTOR criteria

A
  • 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
Q

What is the clinical manifestations of Group A strep pharyngitis

A
  • 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
Q

What are the clinical manifestations of Viral Pharyngitis

A
  • Conjunctivitis
  • Coryza
  • Cough
  • Diarrhea
  • Hoarseness
  • Discrete ulcerative stomatitis
  • Viral exanthema
96
Q

What is the gold standard testing for pharyngitis and tonsillitis

A

Strep culture (swab) if suspected

Gold standard
Takes 24-48 hours to get result

97
Q

CAn you throat swab for mono

A

If mononucleosis is in differential diagnosis → monospot (highly specific & sensitive) & CBC w/ differential—blood test, not a swab

98
Q

What is the tx for GAS pharyngitis

A

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
Q

Does prevention of rheumatic fever in pharyngitis prevent post strep Glomerulonephritis?

A

NO

100
Q

What does PANDAS stand for in Pharyngitis

A

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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