Peds HEENT Flashcards
Most likely organism to cause otitis externa
Pseudomonas
Tx of otitis externa
quinolone abx drops
+/- steroid
PE of serous otitis media
TM is dull with bubbles
No signs of infection; non-erythemous
serous otitis media treatment
self-limiting; 4-6 wks
if no improvement in 3 months, then chronic and needs ET tubes
Ear infection common in pilots and scuba divers
barotitis media (barotrauma)
barotrauma treatment
Valsalva
decongestant
Common etiologies of acute otitis media
viral: 80%
bacteria: strep pneumo, H-flu, Moraxella
Risk factors for otitis media infection
smoke exposure, nighttime bottle, pacifier use, asthma, allergies, ET tube dysfunction
Signs of otitis media
otalgia, hearing loss, fever, URI, ear tugging
PE: TM erythema, bulging, bubbles
When to use abx to treat otitis media?
< 6 mon: ALWAYS
6 mon - 2 yrs: if severe
over 2 yo: watch and see
ABX of choice for otitis media
Amoxicillin 80-90 mg/kg/day or Augmentin
Cefriaxone x 3 days if 1st line fails
What is a cholesteatoma?
collection of trapped epithelial tissue that grow on surface of TM and may cause erosion of mastoid bone
Possible complications of otitis media
cholesteatoma, acute mastoiditis
How to treat acute mastoiditis?
Hospitalize
IV abx to cover strep and staph
Criteria for ET tube placement
- persistent serous OM x 6-12 wks
- recurrent OM 3x/6 mon or 4x/12 mon
“plugged ear” + recent URI + NO fever + retracted TM =
ET dysfunction
Common etiology of acute viral conjunctivitis
Adenovirus
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
Common etiology of acute bacterial conjunctivitis
staph aureus, staph epidermidis, strep pneumo, H flu
How to treat bacterial conjunctivitis?
Cipro
*need 24 hrs of abx to return to school
tx of allergic conjunctivitis
PO anti-histamines
diagnostic sign of oral candidiasis
white plaques in mouth that do not scrape off
tx of oral candidiasis
fluconazole (Nystatin)
bug causing strep throat
Group A beta-hemolytic strep (strep pyogenes)
Centor Criteria for strep throat
- tonsilar exudates
- tender anterior cervical adenopathy
- fever
- 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
