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PEDS exam 2 > PEDS HEENT > Flashcards

PEDS HEENT Flashcards

1
Q

etiology of bacterial conjunctivitis

A
  • streptococcus pneumoniae
  • Haemophilus influenzae
  • moraxella catarrhalis
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2
Q

clinical presentation

  • usually unilateral eye affected; can be bilateral
  • injection (pronounced BV)
  • discharge
    • think, purulent (white, yellow, green)
A

bacterial conjunctivitis

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3
Q

how is bacterial conjunctivitis diagnosed

A

clinically

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4
Q

treatment of bacterial conjunctivitis

A
  • Erythromycin ophthalmic ointment
    • ​0.5 inch applied inside lower lid
  • Trimethoprim-polymyxin B drops
    • ​1-2 drops instilled QID x 5-7 days

**ointment preferred over drops in young children

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5
Q

etiology of neonatal conjunctivitis

A

chlamydia trachomatis

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6
Q

clinical presentation

  • presents between 5-14 days of life
  • orbital swelling
  • watery discharge become mucopurulent
  • chemosis
  • pseudomembrane (exudate adheres to conjunctivae)
  • bloody discharge
A

neonatal conjunctivitis

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7
Q

how do you diagnose neonatal conjunctivitis

A

culture (need to get epithelial cells, not just exudate)

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8
Q

treatment of neonatal conjunctivitis

A
  • Oral Erythromycin
    • 50 mg/kg per day in 4 divided doses x 14 days
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9
Q

etiology of hyperacute bacterial conjunctivitis

A

Neisseria gonorrhoeae

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10
Q

clinical presentation

  • rapidly progressive
  • profuse, purulent discharge
  • marked chemosis
  • typically accompanied by urethritis
  • severe and sight-threatening
A

hyperacute bacterial conjunctivitis

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11
Q

treatment of hyperacute bacterial conjunctivitis

A

immediate opthalmologic referral

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12
Q

contact lens wearers who use extended-use lens have a high risk of what

A

pseudomonal keratitis

  • can cause ulcerative keratitis ->perforation
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13
Q

clinical presentation

  • FB sensation
  • unable to spontaneously open eye
  • typically see corneal opacity with penlight
A

keratitis

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14
Q

treatment of keratitis

A
  • stop contact lens use
  • appropriate Abx coverage (anti-pseudomonal)
  • follow-up eye care provider within 12-24 hours
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15
Q

etiology of viral conjunctivitis

A

adenovirus

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16
Q

clinical presentation

  • injection
  • burning, gritty sensation in the eye
  • discharge
    • watery, scant stringy mucus
  • +/- tender preauricular node
A

viral conjunctivitis

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17
Q

how do you diagnose viral conjunctivitis

A
  • clinical
  • rapid (10 min) test available (adenovirus)
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18
Q

treatment of viral conjunctivitis

A
  • self-limited process
  • warm, or cool compresses
  • topical antihistamine or decongestant
    • OTC: Naphcon-A, Ocuhist
  • lubricant eye drops/ointment (OTC)
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19
Q

when can an individual with infectious conjunctivitis return to school/sports

A
  • stay home until there is no longer any discharge
  • most daycare/schools require at least 24 hrs of topical therapy before returning
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20
Q

clinical presentation

  • bilateral injection
  • discharge
    • watery
  • ocular pruritus
  • eyelid edema
  • mild photophobia
  • +/- associated sneezing, allergic rhinitis
A

allergic conjunctivitis

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21
Q

how do you diagnose allergic conjunctivitis

A

clinically

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22
Q

treatment of allergic conjunctivitis

A

antihistamine with mast cell stabilizing properties

  • olopatadine (patanol, pataday)
  • azelastine HCL (optivar)
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23
Q

Kawasaki disease presents with what symptoms?

A
  • fever: does not respond well to antipyretics

CRASH

  • Conjunctivitis (bilat, nonexudative)
  • Rash (morbilliform)
  • Adenopathy (cervical)
  • Strawberry tongue (cracked, red lips)
  • Hands (red, swollen with desquamation)
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24
Q

what diagnosis should be considered in all children with prolonged unexplained fever > or = 5 days

A

Kawasaki disease

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25
Q

Kawasaki disease has a high risk of what type of complication

A

cardiovascular complication

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26
Q

treatment of Kawasaki disease

A
  • intravenous immunoglobulins and high dose aspirin
  • infectious disease and cardiology consults
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27
Q

what is amblyopia

A
  • vision in one of the eyes is reduced because the eye and the brain are not working together properly
  • brain is favoring the other eye
  • sometimes called lazy eye
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28
Q

what is stabismus

A

misalignment of eyes

*potential to cause amblyopia

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29
Q

how is strabismus diagnosed

A
  • abnormal corneal light reflection test
  • cover/uncover test demonstrates deviation
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30
Q

management of strabismus

A

refer to ophthalmology

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31
Q

what is dacryostenosis

A

nasolacrimal duct obstrcution

*most commo cause of persistent tearing and ocular discharge in infants and young children

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32
Q

clinical presentation

  • chronic, intermittent tearing
  • mucoid discharge
  • debris on lashes
  • mild redness of lower lid from chronic rubbing
A

dacryostenosis

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33
Q

how is dacryostenosis diagnosed

A

clinically

34
Q

treatment of dacryostenosis

A
  • 90% resolve spontaneously
  • lacrimal sac massage - first line treatment
  • beyond 12 months of age, unlikely to resolve spontaneously
35
Q

dacryocystitis

A

inflammation or infection of lacrimal sac

36
Q

etiology of dacryocystitis

A

staphylococcus

37
Q

treatment of dacryocystitis

A
  • obtain cultures
  • treat promptly with empiric Abx (x 7-10 days)
    • oral clindamycin (mild)
  • ophthalmology referral
38
Q

etiology of acute otitis media

A
  • streptococcus pneumonia (50%)
  • Haemophilus influenza (45%)
  • Moraxella catarrhalis (10%)
39
Q

complications of acute otitis media

A
  • TM perforation
  • hearing loss
  • cholesteatoma
  • mastoiditis
40
Q

treatment of acute otitis media

A
  • amoxicillin 80-90 mg/kg/day divided q12 hrs
  • 48-72 hr follow up
41
Q

when should you give Abx to treat acute otitis media

A
  • ALL under 6 months
  • 6 mo-2 yrs if diagnosis is certain OR uncertain diagnosis + fever > 102.2F
  • > or = 2 yrs: fever >102.2F, bilateral ears affected, otalgia > 48 hrs
42
Q

when can you observe and follow up instead of giving abx for AOM

A
  • 6 mo - 2 years: unilateral, nonsevere AOM
  • > 2 years: unilateral or bilat nonsevere AOM
43
Q

when is AOM considered recurrent AOM

A
  • > or = 3 episodes in 6 months
  • > or = 4 episodes per year
44
Q

treatment for recurrent AOM

A
  • prophylactic abx
    • amoxicllin 40 mg/kg/day: daily during winter months
45
Q

clinical presentation

  • retracted TM
  • cloudy, opaque TM
  • air-fluid level
  • decreased, absent mobility of TM
  • hearing loss
A

otitis media with effusion

46
Q

management of otitis media with effusion

A
  • usually resolves spontaneously
  • observation
    • clinical evaluation and hearing test q 3-6 months

**DO NOT treat with Abx

47
Q

how do you diagnose acute otitis media

A
  1. signs and symptoms of middle ear inflammation (otalgia, fever)

AND

  1. abnormal TM exam (bulging TM, erythema)
48
Q

etiology of otitis externa “swimmers ear”

A
  • Pseudomonas aeruginosa
  • staph aureus
49
Q

clinical presentation

  • ear symptoms:
    • otalgia
    • pruritus
    • discharge
  • physical findings
    • hearing loss
    • tragus tenderness
    • erythema and/or edema of ear canal
A

otitis externa “swimmers ear”

50
Q

treatment of otitis externa “swimmers ear”

A

*treat inflammation and infection (topical) and avoid promoting factors

  • Abx
    • ofloxacin, ciprofloxacin otic
    • cortisporin otic
  • glucocorticoid
51
Q

atopy

A

tendency to be “hyperallergic”.

  1. eczema (atopic dermatitis)
  2. allergic rhinitis
  3. allergic asthma
52
Q

clinical presentation

  • allergic shiners
  • accentuated lines/folds below lower lids
    • “Dennie-Morgan lines”
A

allergic rhinitis

53
Q

how do you diagnose of allergic rhinitis

54
Q

treatment of allergic rhinitis

A
  1. allergen avoidance
  2. pharmacotherapy
  3. allergen immunotherapy
55
Q

pharmacotherapy of allergic rhinitis

A
  • steroids
    • intranasal -first line
      • ​fluticasone (flonase)
  • antihistamine
56
Q

when would you start immunotherapy for allergic rhinitis

A

patient has maximized environmental control measures and on optimal medication regimen

57
Q

etiology of viral Upper Respiratory Infection

A

rhinovirus (50%)

58
Q

clinical presentation in infants

  • fever
  • nasal discharge
  • nontoxic appearing
  • fussiness
  • difficulty feeding
  • decreased appetite
  • difficulty sleeping
A

Viral Upper Respiratory Infection

59
Q

clinical presentation is school-aged children

  • nasal congestion
  • nasal discharge
  • cough
  • nontoxic appearing
  • sneezing
  • feverish
A

Viral Upper Respiratory Infection

60
Q

treatment of viral URI

A

anticipatory guidance

  • supportive measures: rest, fluids, nose suction, saline nasal spray
61
Q

complications of Viral Upper Respiratory Infection

A
  • acute otitis media
  • asthma exacerbation
  • acute bacterial sinusitis
  • lower respiratory tract disease (PNA)
62
Q

6-8% of viral URI are complicated by what

A

development of a secondary bacterial rhinosinusitis

63
Q

when do consider that a viral URI has become an acute bacterial rhinosinusitis

A
  • persistent symptoms that are not improving
    • > 10 d, less than 30 days
  • severe symptoms
    • >102.2 F
    • purulent nasal discharge > 3 days
  • worsening symptoms
    • double sickening
64
Q

when is rhinosinusitis considered chronic

A
  • persists for 12 weeks or longer
  • at least two of following:
    • mucopurulent drainage (anterior or posterior)
    • nasal obstruction
    • facial pain
    • decreased sense of smell
65
Q

treatment for bacterial rhinosinusitis

A

amoxicillin-clavulanate (augmentin) 45 mg/kg/day

66
Q

etiology of pharyngitis

A

viral is most common

67
Q

If a patient presents with sore throat and a fever, what other symptoms would suggest the pharyngitis is viral

A
  • rhinorrhea
  • nasal congestion
  • conjuctivitis
  • cough
  • GI symptoms
68
Q

etiology of infectious mononucleosis

A

epstein-Barr virus

69
Q

clinical presentation

  • fever
  • sore throat
  • fatigue
  • PE
    • tender cervical lymphadenopathy
    • splenomegaly
A

infectious mononucleosis

70
Q

how do you diagnose infectious mononucleosis

A
  • heterophile antibody test
    • monospot-rapid serologic test
71
Q

treatment for infectious mononucleosis

A
  • may persist 7-21 days
  • supportive therapy
  • activity restriction for 4 weeks
72
Q

primary etiology of bacterial pharyngitis

A

30% group A streptococci

73
Q

clincal presentation

  • abrupt onset
  • sore throat
  • odynophagia
  • +/- fever
  • PE
    • pharyngeal erythema
    • exudate
    • uvular swelling
    • palate swelling
    • tender cervical lymphadenopathy
A

group A streptococci pharyngitis

74
Q

what are the 6 symptoms that lead towards group A streptococci pharyngitis

*score of 6, likelihood of GAS strep is 85%

A
  1. age (5-15)
  2. season (late fall, winter, early spring)
  3. acute pharyngitis
  4. tender, enlarged cervical lymph nodes
  5. fever (101-103)
  6. absence of symptoms associated with viral URI
75
Q

how do you diagnose group A streptococci pharyngitis

A
  • rapid antigen detection testing for GAS
  • if negative, obtain throat culture
76
Q

treatment of group A streptococci pharyngitis

A
  • oral penicillin, amoxicillin
  • 1st generation cephalosporin
77
Q

complications of group A streptococci pharyngitis

A
  1. acute rheumatic fever
  2. post-streptococcal glomerulonephritis
78
Q

what are the 5 major manifestations of acute rheumatic fever

A
  1. migratory arthritis
  2. carditis
  3. CNS involvement
  4. subcutaneous nodules
  5. erythema marginatum
79
Q

clinical presentation

  • edema
  • gross hematuria
  • hypertension
  • history of recent group A streptococci pharyngitis (1-6 weeks)
A

post-streptococcal glomerulonephritis

80
Q

indications for tonsillectomy

A
  • paradise criteria for tonsillectomy
    • > or = 7 episodes in the last year, at least 5 in each of the past 2 years, at least 3 episodes in the past 3 years
    • episode: Strep throat + fever (>100.9F) OR tonsillar exudate OR cervical adenopathy OR culture confirmed
81
Q

etiology of oral candidiasis (thrush)

A

candida albicans

82
Q

treatment of oral candidiasis

A

nystatin oral suspension

PEDS exam 2 (3 decks)

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