PEDS HEENT

Question 1

Myopia

Answer 1

near sighted

Question 2

Otitis media pharmaceutical treatment

Answer 2

First line–Amoxicillin 80-90mg/kg/24 hours bid
2nd line–Amoxicillin/Clavulanic acid 90mg/kg/day bid
Cefprozil 30mg/kg day bid
Ceftriaxone 50mg/ kg/ day x1 to 3 doses–if child is vomiting or excessive diarrhea
Cefdinir 14mg/kg/ day BID for 10 days

Question 3

When to consult ENT for otitis media

Answer 3

Hearing loss bilaterally of 20 dB or more
Chronic or persistent infection with evidence of mastoid involvement
Any child with 4 or more episodes of AOM in 6-12 month period

Question 4

When to follow up OTITIS MEDIA

Answer 4

Assess child in 48-72 hours for symptom improvement
Return visits are scheduled several days after completion of treatment or re-check 2-3 weeks from initial visit

Question 5

Amblyopia (lazy eye)

Answer 5

Most common cause of visual loss in children.
Marked decrease in visual acuity (most often in one eye) before the age of 7
Three main causes:
Strabismus-misalignment of the eyes
Deprivation-cataracts, hemangioma
Refractive-difference in acuity b/t the two eyes

Question 6

Amblyopia (lazy eye) diagnosis and management

Answer 6

Referral to pediatric ophthalmologist
Recognition and treatment of underlying cause
Follow-up
Make certain the parent keeps the appointment with the ophthalmologist

Question 7

strabismus (crossed-eye)

Answer 7

Major complication is the development of ambylopia, the loss of vision in one or both eyes with an otherwise normal eye exam
One eye is used for fixation while the other eye is allowed to deviate off the visual axis
The cause of strabismus is the lack of visual stimulation of the brain during the critical period of visual development, usually during the first 6 years of life
Abnormal ocular alignment may be due to extraocular muscle weakness, focusing difficulties, unilateral refractive error, nonfusion, or anatomical differences in the eyes

Question 8

Strabismus (crosse-eye) clinical presentation

Answer 8

Any patient with eye deviation that has not resolved by 3months old.
Newborns should be assessed for proper alignment by shining a penlight on the corneal surface
The light should fall on the same position on both eyes
Newborns should always be assessed for the red reflex

Question 9

Leukokoria

Answer 9

white light reflex–needs to be referred immediately

Question 9

Pseudostrabismus

Answer 9

Occurs in infants who have a flat nasal bridge, which gives the appearance of strabismus
Upon testing, the eyes are aligned