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week 1 PC 2 > peds HEENT > Flashcards

peds HEENT Flashcards

1
Q

myopia (nearsightedness)

A

proximal clear, distant blurry
-inherited, lifestyle

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2
Q

myopia s/s

A

difficulty seeing things that are far away, may squint to try and see things clearly

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3
Q

tx of myopia

A

refer to optometry/ophthalmology
-requires glasses or contactst

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4
Q

hyperopia (farsightedness)

A

distance clear, proximal blurred
if uncorrected–> esotropia (crossed eyes) and amblyopia

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5
Q

s/s of hyperopia

A

can’t read books, difficulty seeing screen, difficulty seeing thing that are close
**mild hyperopia normal refractive state for infants/children
-contraction of ciliary body–accommodation and focus

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6
Q

tx of hyperopia

A

refer to ophthalmology as it may interfere with learning or lead to amblyopia

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7
Q

amblyopia

A

secondary to abnormal visual development early in life–decreased visual acuity (fine depth perception)
unilateral= >/2-line difference in visual acuity between eyes
bilateral= visual acuity worse than 20/40 in either eye (in children >/4 yrs) OR worse than 20/50 in either eye (in children </3 yrs)
**limitation= difficult to measure in small children

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8
Q

eval of amblyopia

A

estimation of visual acuity in young children and dx of amblyopia require a complete eye exam by a skilled eye care specialist

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9
Q

strabismus

A

type of amblyopia
ocular misalignment–foveal misalignment
2 different images that can’t be fused into one
leads to suppression of one eye by the visual cortex
suppression–deviation relatives to the fixated eye (fixated eye= the eye getting the clear image)

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10
Q

prefix= direction

A

exo=outward
eso=inward
hyper=upward
hypo=downward

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11
Q

suffix= condition

A

phoria= latent, in the presence of a disruption in binocular vision
tropia= manifest, occurs in the absence of binocular vision disruption

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12
Q

hx

A

-developmental/birth hx
-medical hx: head trauma, other conditions, exposure to toxins (ex: lead)
-meds
-family hx
-OLDCART

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13
Q

physical exam: strabismus

A

general appearance
head posture/tilt
opthalmic exam: cover test, cover/uncover test, Bruckner test, corneal light reflex

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14
Q

cover/uncover test

A

detects latent strabismus. **if the cover test is positive, the cover/uncover test doesn’t necessarily need to be done. if the cover/uncover test is negative, then you want to the cover/uncover test

child will focus on a target, a cover is placed over one eye for a few seconds. then it is rapidly removed. the eye that was covered is observed and noted for the refutation movement back to center and latent strabismus is identified.

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15
Q

cover test

A

child should be focused on a target, you want to cover one eye while observing the opposite eye for movement. if no movement detected, that is considered normal. if strabismus or tropia, the eye that is not occluded with the cover test shifts to refixate on the target. the test should be repeated on each eye. a positive cover test–> should be referred.

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16
Q

Bruckner test (simultaneous red reflex test)

A

checks the red reflex and makes sure it is symmetrical and the pupils are checked for color, symmetry, size, shape, and brightness.
Asymmetry–> referral to pediatric ophthalmologist immediately as this could indicate a series ocular disorder, caner for strabismus, opacities, and retinal tumors

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17
Q

tx for strabismus

A

early recognition for prompt referral to opthamlmolgy
tx may include:
-corrective lenses
-prism lenses
-botox
-vision therapy
-occlusion therapy
-pharm penalization
-surgery
observation and regular follow-up

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18
Q

At 21 days gestation

A

BL ocular tissue visible

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19
Q

8 weeks, 6 days

A

eyelids completely formed, upper/low lids fuse to seal the eye while it develops

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20
Q

16 weeks

A

anterior eye fully developed

21
Q

7 months

A

fetus can open eyes

22
Q

10-12 yrs

A

volume of orbit complete

23
Q

prematurity (early gestational age and low gestational weight)

A

increases the risk of retinopathy of prematurity–> warrants immediate referral to ophthalmology

24
Q

25 weeks-5-6 months

A

most critical time of neurosensory development in the auditory system

25
Q

hearing screening: first

A

otoacoustic emission (OAE)

26
Q

hearing screening: second

A

auditory brainstem response (ABR)

27
Q

hearing screening

A

+OAE—> ABR
+ABR–> ABR

28
Q

sensorineural hearing loss: causes

A

disorders of the inner ear

28
Q

sensorineural hearing loss: types

A

congenital: infection, hereditary
acquired: loud, repetitieve noises, tumors, infection, prematurity, ototoxic drugs, trauma

28
Q

tx of conductive hearing loss

A

removal of cerumen/foreign body
resolution of fluid (treating the middle ear effusion)
hearing aids

28
Q

conductive hearing loss: causes

A

cerumen impaction
middle ear effusion
cholesteatoma
impaired ossicles

28
Q

middle ear effusion

A

caused by fluid buildup in the space behind the eardrum
associated w/ mild conductive hearing loss that normalizes once the effusion resolves

28
Q

tx of sensorineural hearing loss

A

hearing aids
cochlear implants

28
Q

middle ear effusion: s/s

A

symptoms can last up to 12 weeks but should resolve on own
if hearing loss is severe or persistent refer to ENT

29
Q

cholesteatoma

A

squamous epithelium accumulation
congenital or acquired secondary to chronic otitis media

30
Q

cholesteatoma physical exam findings

A

whitish pearl on TM, may appear like tympanosclerosis (whitish scarring on TM) but less fuzzy border

31
Q

management of cholesteatoma

A

REFER TO ENT ASAP
-surgical removal–> structural changes to external auditory canal requiring lifelong ENT f/u

32
Q

labs/diagnostics of cholesteatoma

A

puretone audiogram
CBC w/ diff to r/o anemia or infection
ESR, ANA, RF to r/o autoimmune disease
otoacoustic emissions, tympanometry (OAE)
TSH
CT scan or MRI if tumor is suspected

33
Q

hearing loss

A

intervention services by 3 months, no later than 6 months

34
Q

prevention & management

A

AVOID use of ototoxic drugs (aminoglycosides, diuretics)
reduce repeated exposure to loud noises to avoid acoustic trauma
any pt with sudden onset SNHL should be seen by otolaryngologist immediate (may initiate steroid tx to reverse loss but must be done quickly)
conductive hearing loss TYPICALLY correctable
SNHL is NOT reversible but manageable with cochlear implants when possible

35
Q

when should you refer

A

child fails a hearing screening–> audiology
has a suspected hearing loss–> audiology
any child with hearing loss–> otolaryngologist
infants that fall into SNHL high risk category and/or h/o developmental delay, bacterial meningitis, ototoxic medication exposure, neurodegenerative disorders, mumps or measles
bacterial meningitis–> otolaryngologist bc of concern of cochlear ossification
even if newborn screening passed but at increased risk for progressive or delayed onset hearing loss–> ongoing audio logic monitoring for 3 years and @ appropriate intervals thereafter

36
Q

recurrent strep

A

most likely to occur in settings with close contact facilitating transmissions–> households, schools, daycares
evaluation: repeat testing for GAS

37
Q

what toes a repeat + test mean

A

non adherence
recurrent infection
persistent infection
new and chronic GAS carriage
complication

38
Q

chronic group A strep pharyngitis

A

most likely not going to treat bc less likely to transmit and less likely to develop suppurative complications or acute RF

39
Q

who to treat?

A

local outbreak of acute RF and poststreptococcal glomerulonephritis
outbreak of GAS pharyngitis in closed/semi-closed communities, households, or other close contact settings
Family hx of acute RF
consideration for tonsillectomy solely due to frequent GAS isolations

40
Q

tx for chronic group A strep pharyngitis

A

1st line: clindamycin
**increased risk for C diff

41
Q

tonsillectomy and/or andenoidectomy in children

A

depends on severity and frequency of reinfection
severe: 7+ episodes in one year, 5+ episodes in each of 2 years, 3+ episodes in each of 3 years
mild and moderate: not recommended, benefits don’t outweigh the risk

42
Q

GAS complications to consider

A

h/o peritonsillar abscess
h/o rheumatic heart disease or close contact with a person w/ rheumatic heart disease

week 1 PC 2 (3 decks)

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