Peds HEENT Flashcards by Samantha Camuso

Most likely organism to cause otitis externa

Pseudomonas

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Tx of otitis externa

quinolone abx drops

+/- steroid

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PE of serous otitis media

TM is dull with bubbles

No signs of infection; non-erythemous

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serous otitis media treatment

self-limiting; 4-6 wks

if no improvement in 3 months, then chronic and needs ET tubes

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Ear infection common in pilots and scuba divers

barotitis media (barotrauma)

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barotrauma treatment

Valsalva

decongestant

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Common etiologies of acute otitis media

viral: 80%
bacteria: strep pneumo, H-flu, Moraxella

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Risk factors for otitis media infection

smoke exposure, nighttime bottle, pacifier use, asthma, allergies, ET tube dysfunction

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Signs of otitis media

otalgia, hearing loss, fever, URI, ear tugging

PE: TM erythema, bulging, bubbles

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When to use abx to treat otitis media?

< 6 mon: ALWAYS
6 mon - 2 yrs: if severe
over 2 yo: watch and see

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ABX of choice for otitis media

Amoxicillin 80-90 mg/kg/day or Augmentin

Cefriaxone x 3 days if 1st line fails

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What is a cholesteatoma?

collection of trapped epithelial tissue that grow on surface of TM and may cause erosion of mastoid bone

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Possible complications of otitis media

cholesteatoma, acute mastoiditis

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How to treat acute mastoiditis?

Hospitalize

IV abx to cover strep and staph

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Criteria for ET tube placement

persistent serous OM x 6-12 wks

- recurrent OM 3x/6 mon or 4x/12 mon

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“plugged ear” + recent URI + NO fever + retracted TM =

ET dysfunction

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Common etiology of acute viral conjunctivitis

Adenovirus

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How are viral, bacterial, and allergic conjunctivitis differentiated?

viral is watery discharge and lid edema

bacterial purulent discharge with more redness

allergic has watery discharge and periorbital puffiness; h/o allergies

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Common etiology of acute bacterial conjunctivitis

staph aureus, staph epidermidis, strep pneumo, H flu

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How to treat bacterial conjunctivitis?

Cipro

*need 24 hrs of abx to return to school

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tx of allergic conjunctivitis

PO anti-histamines

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diagnostic sign of oral candidiasis

white plaques in mouth that do not scrape off

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tx of oral candidiasis

fluconazole (Nystatin)

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bug causing strep throat

Group A beta-hemolytic strep (strep pyogenes)

Centor Criteria for strep throat

1. tonsilar exudates 2. tender anterior cervical adenopathy 3. fever 4. No cough

Labs to differentiate different causes of pharyngitis

rapid strep antigen test | Mono spot

strep throat tx

penicillins

sandpaper rash + pharyngitis + pastias lines

Scarlet fever

Scarlet fever treatment

penicillin

Jones criteria

criteria to dx Rheumatic Fever; must have 2 major or 1 major with 2 minor + prior hx of strep infection Major: Joints, carditis, Nodules, Erythema marginatum, Sydenham's chorea Minor (inflamm markers): fever, arthralgia, increased ESR/CRP, leukocytosis, prolonged PR interval

Viral causes of pharyngitis

Coxsackie, Adenovirus, Influenza, EBV, HIV

Rheumatic fever tx

PCN, aspirin cardiac eval

Complications post strep infection

Scarlet fever Rheumatic fever Post-strep glomerulonephritis

UA: cola-colored, RBC casts, hematuria, proteinuria. Dx?

glomerulonephritis

What lab should be ordered to see if patient had recent strep infection?

ASO titer

How is Mono differentiated from strep?

fatigue, tender POSTERIOR cervical adenopathy, caused by EBV virus

hot potato voice and drooling indicates ________.

peritonsillar abscess

What is tonsiladenitis?

extreme obstruction of nasopharygeal or oropharyngeal airways

When are tonsils and adenoids removed surgically in children?

recurrent infections: 3 in each of past 3 yrs 5 in each of past 2 yrs 7 in past year

Child who is irritable, drooling, and has neck in hyper-extended position.

epiglottitis

Bug causing epiglottitis

H-flu type B

XR shows ______ with epiglottis.

thumb sign

Child with inspiratory stridor that worsens in supine position. otherwise normal exam.

laryngomalacia - congenital flaccidity of laryngeal

XR with steeple sign pathognomonic for _______.

croup

Croup tx

corticosteroids, racemic epinepherine

Common causes of URI

Rhinovirus, coronavirus, RSV, parainfluenza

If nasal polyps seen in patient younger than 10 yo, consider _____ and order ____ lab.

Cystic fibrosis | chloride sweat test

Child with barky cough and stridor that is worse at night.

Croup

Common cause of croup

parainfluenza, influenza, RSV

choanal atresia

bony or membranous occlusion of 1 or both nasopharynx openings

Most common causes of bacterial sinusitis

strep pneumo, H-flu, Moraxella

1st line therapy for bacterial sinus infection

amoxicillin x 10-14 d | macrolide if allergic

cleft palate associated with what chromosomal abnormalities?

trisomy 13 (Patau) and 18 (Edwards)

Maternal phenobarbital use increases risk of __________ in newborn.

cleft lip/palate, neural tube defects, microcephaly

Male child with hematuria, sensorineural hearing loss, and visual changes. What is next best step in dx?

renal bx to evaluate child for Alport syndrome

Child with hearing loss and white forelock.

Warrdenburg syndrome

sore throat + grey pseudomembrane

diphtheria

How to differentiate acute OM and OM with effusion?

TM in AOM is bulging; discharge | TM in OME is neutral or retracted; bubbles