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D2 E1 Shea > PEDS HEENT 2 > Flashcards

PEDS HEENT 2 Flashcards

1
Q

+/- 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?

A

AOM

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2
Q

What will you find on the PE of AOM?

A

erythematous, bulging TM & middle ear infection

If TM perforated: canal w/exudate

may visualize perf of TM

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3
Q

Tx of AOM

A

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

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4
Q

When should you refer AOM pt to ENT for evaluation?

A

>4 episodes/yr, possible hearing problems

Myringotomy w/tympanostomy tubes (Pressure equalizing tubes)

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5
Q

How do you tx OM w/PE tubes?

A

Tympanostomy tube otorrhea (TTO)

fluoroquinolone +/- corticosteroid

ciprofloxacin + dexamethasone (Ciprodex)

Oral abx if severe infection

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6
Q

Presence of middle-ear effusion (fluid buildup) without infection

What condition is this?

A

Serous Otitis Media

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7
Q

Pain, pressure, “popping”, decreased hearing, disequilibrium

Sx of which condition?

A

Serous otitis media

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8
Q

What will you find on PE of Serous otitis media?

A

TM grey, shiny

TM normal or retracted

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9
Q

Dx of Serous otitis media

A

clinical: TM is immobile

Tympanometry

bubbles/fluid level may be visible

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10
Q

What are some common risk factors of serous otitis media?

A

follows resolution of undx AOM

daycare center attendance

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11
Q

Tx of serous otitis media

A

self limited, takes 12 wks

if persistent >3m0 = ENT referral

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12
Q

T/F: You can use steroids/antihitamines/decongestants for OME in children

A

False, you CANNOT use steroids/antihistamines/decongestants for OME in children

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13
Q

Common in AZ during the summer months

“swimmers ear”

What condition?

A

Otitis Externa

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14
Q

Significant unilateral ear pain

Malodorous discharge from ear canal

Sx of what condition?

A

Otitis Externa

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15
Q

What do you see on PE of Otitis Externa?

A

tragal tenderness

exudate in ear canal

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16
Q

Tx of Otitis Externa

A

Ciprodex (abx drops)

If TM perf: FQ suspension

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17
Q

How can you prevent Otitis Externa?

A

Swim-ear OTC

50/50 rubbing alcohol & white vinegar post swimming

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18
Q

How do you remove a foreign body?

A

Tiny forceps

superglue/cotton swab

mouth-to-mouth

Avoid pushing object deeper, refer to ENT if problematic

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19
Q

How do you tx aural foreign body?

A

attempt irrigation 1st if TM is intact

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20
Q

Sx of what condition?

  • Sneezing
  • Rhinorrhea
  • Nasal congestion
  • Scratchy sore throat
  • Pruritus
  • Tearing
  • Cough
  • Snoring
  • Sniffles
  • Anosmia
  • Headache
  • Fatigue
A

Allergic rhinitis

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21
Q

What do you see on PE in allergic rhinitis?

A

Allergic shiners

Nasal crease: “Allergic salute”

Pale, blueish/boggy nasal mucosa

Clear rhinorrhea

“cobblestone” appearance of posterior pharynx

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22
Q

Tx of allergic rhinitis for pts >2yo

A

Intranasal steroid sprays: Nasacort, Nasonex

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23
Q

Tx of allergic rhinitis for pts >4 yo

A

Flonase

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24
Q

Which antihistamines can you use to tx allergic rhinitis?

A

1st gen: diphenhydramine

2nd gen: cetirizine

Intranasal: azelastine, olopatadine

25
Q

What is a long term tx option for allergic rhinitis?

A

Immunotherapy

26
Q

> 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?

A

Sinusitis

27
Q

What is the MC bacterial pathogen causing sinusitis?

A

S. Pneumo

28
Q

Dx of sinusitis if >30d (chronic)

A

Water’s view radiograph

May culture- usually done by ENT

29
Q

Tx of sinusitis

A

(Augmentin) 45/mg/kg/d divided BID

or

Amoxicillin 90mg/kg/d divided BID

30
Q

What 3 pathogens are MCC of sinusitis?

A

H. flu

S. pneumo

M. catt

31
Q

What other condition should you consider if sinusitis is recurrent/severe?

A

cystic fibrosis

32
Q

What is the MCC of pharyngitis?

A

Viral!

adenoviruses, rhinovirus, coxsackie A viruses, Epstein Barr Virus, influenza, or parainfluenza virus

33
Q

red throat, congestion, fever, fatigue, swollen cervical nodes

Sx of what condition?

A

Pharyngitis

34
Q

Tx of pharyngitis

A

Education for parents

Analgesics

Fluids

Rest

35
Q

Exudative tonsillitis, cervical lymphadenopathy, fatigue & malaise, headache, fever, splenomegally

Incubation period 4-8 weeks

Which condition?

A

Pharyngitis: EBV aka MONO

36
Q

Dx of Pharyngitis: EBV (MONO)

A

Fingerstick (Monospot® )

EBV titers

37
Q

Tx of Pharyngitis: EBV aka MONO

A

Spleen precautions x 6-8 weeks

No contact sports, rough-housing, etc.

38
Q

Usually abrupt onset

Fever, sore throat, headache, nausea, abdominal pain, rash

Watch fluid intake!

Which condition and for which age group?

A

Sx > 3 yo of Pharyngitis: GABHS

39
Q

atypical sx= nasal congestion, low grade fever, ant cervical LA

Which condition and which age group?

A

<3yo GABHS Pharyngitis

40
Q

What would you find on PE of Pharyngitis: GABHS

A

exudative tonsillitis

•enlarged tender anterior cervical lymph nodes,

palatal petechiae

•+/- scarlatiniform rash

Halitosis

Coated tongue

41
Q

Dx of GABHS

A

Rapid strep antigen test

42
Q

What is the gold standard dx of GABHS

A

throat culture

43
Q

What should you do next if you get a negative rapid strep test?

A

throat culture

may take >48 h

44
Q

Tx of GABHS

A

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)

45
Q

Tx of GABHS in pt w/ non-anaphylactoid PCN allergy

A

Cephalexin

46
Q

Tx of GABHS in pts w/ Type 1 hypersensitivity PCN allergy

A

Clindamycin 30mg/kg/d x 10 days divided TID

47
Q

2-3 weeks post strep infection, usually peds 5-15 yo

Which condition?

A

Acute Rheumatic Fever

48
Q

Major Jones Criteria for ARF

A

Migrating polyarthritis

Carditis and valvulitis

Chorea

Erythema marginatum

Subcutaneous nodules

49
Q

Minor Jones Criteria for ARF

A

Arthralgia

Fever

Elevated ESR or CRP

Prolonged PR interval

50
Q

Dx of ARF

A

2 major

or

1 major + 2 minor

ASO titers

51
Q

T/F: Rheumatic heart disease is the #1 cause of acquired valve disease worldwide.

A

TRUE

52
Q

Tx of ARF

A

Amoxicillin (may require ongoing prophylaxis through adulthood) + Aspirin

53
Q

What must you evaluate for in ARF?

A

carditis (cardiomegaly, CHF, 3rd degree block)

54
Q

Inflammation of the glomeruli secondary to deposition of immune complexes

What condition?

A

Post-streptococcal Glomerulonephritis (PGN)

55
Q

Edema (#1), hematuria (tea-colored urine), proteinuria, hypertension (Na+ & H20 retention)

Sx of what condition?

A

PGN

56
Q

Dx of PGN

A

ASO titers

57
Q

Tx of PGN

A

self limited

may require diuretics if HTN and edema persistent

58
Q
A

D2 E1 Shea (13 decks)

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