PEDS HEENT 2 Flashcards
+/- fever ( ≥ 100.4 °F)
Ear pain
Infants- poor feeding, pulling at ear, batting at head, poor sleeping, fussiness
Older children- c/o ear pain, c/o sinus tenderness, headache, decreased hearing, c/o dizziness
Usually concurrent or following URI
Which condition?
AOM
What will you find on the PE of AOM?
erythematous, bulging TM & middle ear infection
If TM perforated: canal w/exudate
may visualize perf of TM
Tx of AOM
Up to 2 yrs: abx
> 2 yrs: Healthy, unilateral OM, mild sx, no drainage= Observe for 48h
Toxic, sx> 48h, T ≥ 102.2, F/U, bilateral OM or otorrhea= Abx
Abx of choice: Amoxicillin 80-90mg/kg/day x 10 days
When should you refer AOM pt to ENT for evaluation?
>4 episodes/yr, possible hearing problems
Myringotomy w/tympanostomy tubes (Pressure equalizing tubes)
How do you tx OM w/PE tubes?
Tympanostomy tube otorrhea (TTO)
fluoroquinolone +/- corticosteroid
ciprofloxacin + dexamethasone (Ciprodex)
Oral abx if severe infection
Presence of middle-ear effusion (fluid buildup) without infection
What condition is this?
Serous Otitis Media
Pain, pressure, “popping”, decreased hearing, disequilibrium
Sx of which condition?
Serous otitis media
What will you find on PE of Serous otitis media?
TM grey, shiny
TM normal or retracted
Dx of Serous otitis media
clinical: TM is immobile
Tympanometry
bubbles/fluid level may be visible
What are some common risk factors of serous otitis media?
follows resolution of undx AOM
daycare center attendance
Tx of serous otitis media
self limited, takes 12 wks
if persistent >3m0 = ENT referral
T/F: You can use steroids/antihitamines/decongestants for OME in children
False, you CANNOT use steroids/antihistamines/decongestants for OME in children
Common in AZ during the summer months
“swimmers ear”
What condition?
Otitis Externa
Significant unilateral ear pain
Malodorous discharge from ear canal
Sx of what condition?
Otitis Externa
What do you see on PE of Otitis Externa?
tragal tenderness
exudate in ear canal
Tx of Otitis Externa
Ciprodex (abx drops)
If TM perf: FQ suspension
How can you prevent Otitis Externa?
Swim-ear OTC
50/50 rubbing alcohol & white vinegar post swimming
How do you remove a foreign body?
Tiny forceps
superglue/cotton swab
mouth-to-mouth
Avoid pushing object deeper, refer to ENT if problematic
How do you tx aural foreign body?
attempt irrigation 1st if TM is intact
Sx of what condition?
- Sneezing
- Rhinorrhea
- Nasal congestion
- Scratchy sore throat
- Pruritus
- Tearing
- Cough
- Snoring
- Sniffles
- Anosmia
- Headache
- Fatigue
Allergic rhinitis
What do you see on PE in allergic rhinitis?
Allergic shiners
Nasal crease: “Allergic salute”
Pale, blueish/boggy nasal mucosa
Clear rhinorrhea
“cobblestone” appearance of posterior pharynx
Tx of allergic rhinitis for pts >2yo
Intranasal steroid sprays: Nasacort, Nasonex
Tx of allergic rhinitis for pts >4 yo
Flonase
Which antihistamines can you use to tx allergic rhinitis?
1st gen: diphenhydramine
2nd gen: cetirizine
Intranasal: azelastine, olopatadine
What is a long term tx option for allergic rhinitis?
Immunotherapy
> 10-14 d of sx without improvement
Can be misleading due to overlap of sx w viral URI
Purulent nasal d/c
Sinus pain
+/- Fever
Halitosis
Headache
Dental pain
Sx of which condition?
Sinusitis
What is the MC bacterial pathogen causing sinusitis?
S. Pneumo
Dx of sinusitis if >30d (chronic)
Water’s view radiograph
May culture- usually done by ENT
Tx of sinusitis
(Augmentin) 45/mg/kg/d divided BID
or
Amoxicillin 90mg/kg/d divided BID
What 3 pathogens are MCC of sinusitis?
H. flu
S. pneumo
M. catt
What other condition should you consider if sinusitis is recurrent/severe?
cystic fibrosis
What is the MCC of pharyngitis?
Viral!
adenoviruses, rhinovirus, coxsackie A viruses, Epstein Barr Virus, influenza, or parainfluenza virus
red throat, congestion, fever, fatigue, swollen cervical nodes
Sx of what condition?
Pharyngitis
Tx of pharyngitis
Education for parents
Analgesics
Fluids
Rest
Exudative tonsillitis, cervical lymphadenopathy, fatigue & malaise, headache, fever, splenomegally
Incubation period 4-8 weeks
Which condition?
Pharyngitis: EBV aka MONO
Dx of Pharyngitis: EBV (MONO)
Fingerstick (Monospot® )
EBV titers
Tx of Pharyngitis: EBV aka MONO
Spleen precautions x 6-8 weeks
No contact sports, rough-housing, etc.
Usually abrupt onset
Fever, sore throat, headache, nausea, abdominal pain, rash
Watch fluid intake!
Which condition and for which age group?
Sx > 3 yo of Pharyngitis: GABHS
atypical sx= nasal congestion, low grade fever, ant cervical LA
Which condition and which age group?
<3yo GABHS Pharyngitis
What would you find on PE of Pharyngitis: GABHS
exudative tonsillitis
•enlarged tender anterior cervical lymph nodes,
palatal petechiae
•+/- scarlatiniform rash
Halitosis
Coated tongue
Dx of GABHS
Rapid strep antigen test
What is the gold standard dx of GABHS
throat culture
What should you do next if you get a negative rapid strep test?
throat culture
may take >48 h
Tx of GABHS
abx: Penicillin VK 25-50 mg.kg/d div BID x 10 d
Alt:
Amoxicillin 50 mg/kg/d divided BID x 10 days
or
Penicillin G IM (one dose)
Tx of GABHS in pt w/ non-anaphylactoid PCN allergy
Cephalexin
Tx of GABHS in pts w/ Type 1 hypersensitivity PCN allergy
Clindamycin 30mg/kg/d x 10 days divided TID
2-3 weeks post strep infection, usually peds 5-15 yo
Which condition?
Acute Rheumatic Fever
Major Jones Criteria for ARF
Migrating polyarthritis
Carditis and valvulitis
Chorea
Erythema marginatum
Subcutaneous nodules
Minor Jones Criteria for ARF
Arthralgia
Fever
Elevated ESR or CRP
Prolonged PR interval
Dx of ARF
2 major
or
1 major + 2 minor
ASO titers
T/F: Rheumatic heart disease is the #1 cause of acquired valve disease worldwide.
TRUE
Tx of ARF
Amoxicillin (may require ongoing prophylaxis through adulthood) + Aspirin
What must you evaluate for in ARF?
carditis (cardiomegaly, CHF, 3rd degree block)
Inflammation of the glomeruli secondary to deposition of immune complexes
What condition?
Post-streptococcal Glomerulonephritis (PGN)
Edema (#1), hematuria (tea-colored urine), proteinuria, hypertension (Na+ & H20 retention)
Sx of what condition?
PGN
Dx of PGN
ASO titers
Tx of PGN
self limited
may require diuretics if HTN and edema persistent
