PEDS HEENT 1 Flashcards
Thick, purulent, ropy disharge
Usually starts unilaterally
Eyelids may be “crusted shut” in a.m.
+/- preauricular lymphadenopahty
Clinical px of what condition?
Bacterial conjunctivitis
Cause of Bacterial conjunctivitis
S. pneumoniae, H. influenza, M. cattarhalis, S. aureus
Newborns: Chlamydia trachomatis #1
Tx of bacterial conjunctivitis
Antibiotic ointment-infants
Antibiotic drops- older children
_**treat both eyes!!_
Cause of viral conjunctivitis
adenovirus: one of the primary causes of ‘colds’ (URI)
conjunctival injection of one or both eyes
watery ocular discharge, some crusting in a.m.
Typically bilateral
May be accompanied by URI sx, feels “gritty”
Clinical Px of what?
Viral conjunctivitis
Viral conjunctivitis Tx
self-limited
bilateral itchy, watery, red eyes
watery discharge/tearing
“Bumpiness” of tarsal conjunctivae
Accompanied by sx of allergic rhinitis
Sneezing, dry cough, atopic dermatitis
Clinical Px of what?
Allergic Conjunctivitis
Allergic conjunctivitis Tx
symptomatic:
olopatadine in children > 2 years
Reduce exposure
Cause of Periorbital cellulitis (preseptal)
(Infection ANTERIOR to orbital septum)
exogenous source ( eyelid abrasion, horedolum, chalazion, dacrocystitis, insect bite)
MC pathogen = Staph aureus & S. pyogenes
2 MC pathogens of peri-orbital cellulitis
Staph aureus & S. pyogenes
T/F:
Periorbital cellulitis/orbital cellulitis infections arise POSTERIOR to the orbital septum
False, Periorbital cellulitis/orbital cellulitis infections arise ANTERIOR to the orbital septum
T/F:
Periorbital cellulitis has mild, minimal complications
TRUE
Periorbital Cellulitis Tx
oral/systemic abx
(Augmentin)
infection POSTERIOR to the orbital serum
may cause serious complications- such as an acute ischemic optic neuropathy or cerebral abscess
This describes which condition?
Orbital cellulitis
Cause of Orbital cellulitis
(2 MC pathogens?)
Staph or Strep (S. aureus)
T/F:
Orbital cellullitis is almost always associated w rhinosinusitis or sinus infection
True
+/- fever (if present, it is high)
lid swelling & erythema
vision disturbances/decreased vision
Pain w EOMs, proptosis (protruding eye)
Clinical px of which condition?
Orbital Cellulitis
Dx of orbital cellulitis
CT or MRI
Tx of orbital cellulitis
Emergent Opthalmology Consult; IV abx
+/- surgical drainage
Widespread inflammation of medium and small arteries, including the coronary arteries
aka “mucocutaneous lymph node syndrome”
Which condition?
Kawasaki Dz
Dx of Kawasaki Dz
+/- anemia & thrombocytosis
no specific dx criteria
What is the leading cause of acquired heart dz in children in US?
Kawasaki Dz
Boys>girls (1.5:1)
Transmissible to household contacts; clustering
Some clinical features similar to adenovirus and scarlet fever
Seasonality (winter and spring)
80% of cases occur in children < 5 yo (median age at diagnosis is 2yo)
Epidemiology of which condition?
Kawasaki Dz
Dx criteria of Kawasaki Dz
Fever plus:
- Conjunctivitis: bilateral, bright-red, non-exudative
- Mucositis: cracked lips, strawberry tongue
- Polymorphous rash & desquamation: starts in perineum, skin peels, then spreads
- Lymphadenopathy: cervical
- Extremity changes: edema, redness of palms/soles
“Can’t make pain leave, eek!”
Details of Mgmt of Kawasaki Dz: IVIG
IVIG (intravenous immune globulin) + Aspirin (ASA) (80-100mg/kg/d)
IVIG reduces incidence of aneurysms
DO NOT admin live vaccines within 11 mos of IVIG
General Mgmt of Kawasaki Dz
IVIG + Aspirin
Baseline Echo + repeat @ 2 & 6 wks
Complications of Kawasaki Dz
CV: coronary artery aneurysms –> myocardial ischemia, infarction, sudden death
Highest risk: < 1yr & >9yrs
Loss of the most superficial layer of corneal cells
What is this?
Corneal Abrasion
Red eye, watery d/c (tearing)
blephorospasm (tight closure of eyelid)
Severe ocular pain
Fussy baby, irritable toddler
Rubbing at eye
“squinting”/photophobia
Corneal Abrasion
Corneal Abrasion Dx
fluorescein stain, Wood’s lamp**
If foreign body refer to Opthalmology
Corneal Abrasion Tx
erythromycin ointment & recheck in 24-48 h
patching the affected eye?
If no decrease in size, refer to Opthalmology
Most common cause of persistent tearing & eye discharge in infants & children
Which condition?
Dacryostenosis
chronic or intermittent tearing, debris on lashes
generally NO conjunctival irritation, however, injection may occur from irritation or overflow tearing
palpable nasolacrimal sac +/- discharge or reflux of tears
Clinical Px of which condition?
Dacryostenosis
Tx of dacryostenosis
lacrima sac massage in downward direction 2-3x a day
refer to optho if sx persist >6mo
infection of the nasolacrimal sac that causes erythema & edema over the nasolacrimal sac
commonly caused by bacteria that colonize upper respiratory tract
S. aureus, S. pneumoniae, S. pyogenes, S. viridans, M. catarrhalis & Haemophilus species
Which condition?
Dacryocystitis
Tx of dacryocystitis
milder cases = PO+ topical abx
severe acute = IV antibiotics (after culture & staining)
Functional reduction in visual acuity
Caused by abnormal vision development early in life
What dz?
amblyopia
Most common cause of pediatric visual impairment
Amblyopia
T/F: amblyopia is usually bilateral
False, amblyopia is usually unilateral
Can occur only during the critical period of visual development in the 1st decade of life when the visual nervous system is plastic
Which condition?
Amblyopia
Misalignment of the eyes
Categorized by the direction of the deviation: esotropia, exotropia, hypertropia, hypotropia
constant or intermittent
Which condition?
Strabismus
Risk factors for strabismus
+ FH
low birth weight (prematurity)
Periorbital or Orbital?
- Vision & EOMs are normal
- Erythematous & edematous eyelids, main, mild fever
Peroribital Cellulitis (pre-septal)
Periorbital or Orbital?
- Pain w/ EOMs
- Proptosis (protruding eye)
- Emergent Opthalmology Consult: IV abx
