Peds HEENT Flashcards
Presentation of bacterial conjunctivitis?
Thick, purulent, ropy disharge
Usually starts unilaterally
eyelids may be crusted shut in AM
+/- preauricular lymphadenopathy
Pathogens responsible for bacterial conjunctivitis? In newborns?
S. pneumoniae, H. influenza, M. cattarhalis, S. aureus
Newborns: Chlamydia trachomatis #1
Tx for bacterial conjunctivitis?
Antibiotic ointment-infants
Antibiotic drops- older children
**treat both eyes!!
Organism involved in viral conjunctivitis?
adenovirus
Presentation of viral conjunctivitis?
usually present w/ injection of the conjunctiva of one or both eyes & watery ocular discharge
Typically bilateral
injected conjunctiva
DC is typically watery, some crusting in a.m
Tx for viral conjunctivitis?
supportive
What is periorbital cellulitis?
infections arising ANTERIOR to the orbital septum
generally mild, minimal comps
usually arises from exogenous source (i.e. abrasion of eyelid, hordeolum, chalazion, dacryocstitits, insect bite, etc)
What is orbital cellulitis?
infection POSTERIOR to the orbital serum
may cause serious
complications- such as an acute ischemic optic neuropathy or cerebral abscess
Is orbital cellulitis MCly seen in adults or children?
children
What is Kawasaki disease?
Widespread inflammation of medium and small arteries, including the coronary arteries
What is the leading cause of acquired heart disease in children in US?
Kawasaki disease
epidemiology of Kawasaki disease?
Boys > girls
More common in Asians
80% in children <5
Dx criteria for KD?
Fever +
conjunctivitis: bi, bright red
Mucositis
Polymorphous rash & desquamation
Lymphadenopathy
extremity changes: edema, redness of palms/soles
Tx of KD?
IVIG +ASA 80-100mg
(most effective within 7-10d)
Baseline echo, then repeat at 2 and 6wks
Complications of KD?
coronary artery aneurysms: MI, infarction, sudden death
myocarditis, arrhythmias
What may be seen on CBC in pt with KD?
anemia and thrombocytosis
What is a corneal abrasion?
Loss of the most superficial layer of corneal cells
S/s of corneal abrasion?
Severe ocular pain
Red eye, watery d/c,
blephorospasm (tight closure of eyelid)
others: fussy baby, rubbing eye, squinting
Dx of corneal abrasion?
Apply fluorescein stain & evaluate w/ Wood’s lamp**
If FB refer to Opthalmology
Tx of corneal abrasion?
abx ointment and recheck in 24-48 hrs
-erythromycin ointment
if no decrease in size, refer to optho
What is dacryostenosis?
Nasolacrimal duct obstruction
occurs in up to 6% of newborns
MC of persistent tearing and eye DC in infants and children
S/s of dacryostenosis?
chronic or int. tearing, debris on lashes
generally NO conjunctival irritation, but, injection may occur from irritation or overflow tearing
palpable nasolacrimal sac +/- DC or reflux of tears
Tx of dacryostenosis?
Lacrimal sac massage in downward direction 2-3x a day
Obs
refer to optho if sx persist past 6 mo
What is dacrocystitis?
infection of the nasolacrimal sac that causes erythema & edema over the nasolacrimal sac
Secondary infection of Dacryostenosis
Organisms involved in dacrocystitis?
commonly caused by bacteria that colonize upper respiratory tract:
S. aureus, S. pneumoniae, S. pyogenes, S. viridans, M. catarrhalis & Haemophilus species
S/s of dacrocystitis?
Swelling, erythema/edema over nasolacrimal sac
Tx of dacrocystitis?
severe acute dacryocystitits = IV antibiotics (after culture & staining)
milder cases = PO antibiotics (topical in conjunction)
S/s AOM?
+/- fever
ear pain
infants: poor feeding, pulling at ear
older children: ear pain, HA, dizziness
usually concurrent or following URI
PE findings of AOM?
Erythematous, bulging TM & MEE (middle ear effusion)
If perforation of TM : canal w/ exudate, may visualize perf on TM
Tx for AOM?
up to 2: tx with abx
> 2 yrs: healthy, unilateral, mild sxs: observe for 48hrs
> 2 yrs: toxic sxs, bilateral: tx with abx
First line drugs for AOM? 2nd line alternatives?
amoxicillin 80-90mg/kg per day x 10d
Augmentin
Cefdinir
Cefpodoxime
Management for recurrent AOM?
refer to ENT
> 4episodes/yr, possible hearing problems
myringotomy with tympanostomy tubes
tx of OM with tympanostomy tubes?
otic fluoroquinolone abx drops +/- corticosteroid
oral abx if severe infection
What is serous OM?
Presence of middle-ear effusion (fluid buildup) without infection
S/s of Serous OM?
Pain, pressure, “popping”, decreased hearing, disequilibrium
PE findings for serous OM?
TM grey, shiny
TM normal or retracted
Diagnosis of serous OM?
clinical
pneumatic otoscope: TM immobile
bubbles/fluid may be visible
RF for serous OM?
may follow undx AOM, fam hx OM, bottle feeding, day care, exposure to tobacco smoke
S/s of otitis externa?
Significant ear pain, usually unilateral
Malodorous discharge from ear canal
PE for otitis externa?
Tragal tenderness, exudate in ear canal
Tx of otitis externa?
abx drops: ciprodex, ofloxacin, hydrocortisone
If TM perforation: suspension fluroquinolone
What can you use to prevent swimmer’s ear? (otitis externa)
OTC 50/50 rubbing alcohol & white vinegar after swimming
Presentation of nasal FB?
usually asxs early on
congestion, foul smelling/purulent/blooding DC
periorbital cellulitis in severe cases
removal of nasal FB?
tiny forceps, superglue/cotton swab mouth-mouth
avoid pushing object deeper–> refer to ENT
aural FB removal
same as nasal but try irrigation first
s/s allergic rhinitis
sneezing, rhinorrhea, nasal congestion, sore throat, pruritus, cough, tearing, etc.
What is the atopic triad?
allergies, asthma and eczema (atopic dermatitis)
PE findings in allergic rhinitis?
allergic shiners
nasal crease
pale/blueish nasal mucosa
clr rhinorrhea
cobblestoning of posterior pharynx
tx of allergic rhinitis?
intranasal steroid sprays
antihistamines: oral and intranasal- usually 2nd gen
avoid triggers
immunotherapy
s/s of sinusitis?
10-14 d of sx without improvement
Can be misleading due to overlap of sx w viral URI
purulent nasal DC, sinus pain, +/- fever, halitosis, HA, dental pain
pathogen for bacterial sinusitis?
S. pneumoniae
H. influenza
M. cattarhalis
dx of sinusitis?
clinical
if chronic (>30days)
- water’s view xray
- culture
- CT sinuses
sxs tx for sinusitis?
Intranasal saline irrigation
Analgesics
Humidifier/vaporizer
s/s of pharyngitis?
red throat, congestion, fever, fatigue, swollen cervical nodes
Likely pathogen for pt with viral pharyngitis and bilateral conjuctivitis?
adenovirus
tx for viral pharyngitis?
pt ed
pain control, fluids, rest
What is EBV?
infectious mononucleosis
MC in adolescents
s/s of EBV?
Exudative tonsillitis, cervical lymphadenopathy, fatigue & malaise, headache, fever, splenomegally
Incubation of EBV?
4-8 wks
Dx of EBV?
fingerstick (monospot)
EBV titers
Tx of EBV
spleen precautions: no contact sports
monitor fluids/airways
analgesics
+/- steroids
sxs of GABHS in children >3 y/o
usually abrupt onset
Fever, sore throat, headache, nausea, abdominal pain, rash
Watch fluid intake!
sxs of GABHS in pts <3?
nasal congestion, low grade fever, ant cervical LA
PE findings in GABHS?
exudative tonsillitis enlarged tender anterior cervical lymph nodes, palatal petechiae \+/- scarlatiniform rash Halitosis Coated tongue
Dx of GABHS
rapid strep antigen test
throat
Tx of GABHS?
abx, pain control, fluids
Amoxicillin 50mg/kg/d divided BID x 10 days
What is acute rheumatic fever?
2-3 weeks post strep infection, usually peds 5-15 yo
s/s of acute rheumatic fever?
Jones’ criteria:
Major criteria
- Migrating polyarthritis
- Carditis and valvulitis
- Chorea (
- Erythema marginatum
- Subcutaneous nodules
Minor criteria
- Arthralgia
- Fever
- Elevated ESR or CRP
- Prolonged PR interval
high likelihood of ARH if…
2 major or 1 major and 2 minor criteria
Why do we care about ARF?
can cause rheumatic heart disese 10-20 yrs later
dx of ARF?
Antistreptolysin-O (ASO) titers
Strep antigen and/or throat cx will likely be negative
Tx of ARF?
abx + antiinflammatories
Amoxicillin
ASA
eval for carditis
What else can happen if strep throat is left untreated?
Post-streptococcal Glomerulonephritis (PGN)
Inflammation of the glomeruli secondary to deposition of immune complexes
s/s of PGN?
Edema (#1), hematuria (tea-colored urine), proteinuria, hypertension (Na+ & H20 retention)
dx of PGN? tx?
Antistreptolysin O titers (ASO titers)
usually self limited
diuretics if persistent HTN and edema
Pathogen involved in peritonsillar abscess?
Usually S. pyogenes, but may be polymicrobial
s/s of peritonsillar abscess?
Difficulty & pain with swallowing Drooling, decreased PO intake, Unwillingness to extend the neck, muffled/"hot potato“ voice, Respiratory distress, Neck swelling/lymphadenopathy Trismus
dx of peritonsillar abscess?
Clinical
Uvula deviated
Edema of anterior tonsilar pillar
CT w/ contrast
Aspiration
management of peritonsillar abscess?
Airway!
Surgical drainage
Antibiotics
Describe coxsackie virus
“Hand, foot & mouth disease”
Oral lesions (“Herpangina”), esp on tongue, palate & tonsillar pillars
Maculopapular or vesicular rash on hands and feet
Presentation of hand foot mouth disease
usually < 5 y/o, day care
low grade fever, decreased POs, sore throat, HA
tx for hand foot mouth disease?
supportive
popsicles
Describe Herpetic Gingivostomatitis
Primary HSV-1 infection
Ulcerative lesions of the gingiva and mucous membranes, occasionally with perioral lesions
s/s of herpetic gingivostomatitis?
3-4 day “prodrome”
Fever, sleeplessness, HA,
Ulcerated lesions that bleed if disturbed
Tx of herpetic gingivostomatitis?
NSAIDs
HYDRATION
Oral acyclovir if sx < 4d & possibility of dehydration
Incubcation period of measles? Prodrome of measles?
6-19 days
Fever, malaise, anorexia followed by conjunctivitis, coryza & cough, Koplik’s spots
Presentation of diaper candidiasis
“Beefy Red” erythema with satellite lesions
Usually a result of poorly treated irritant dermatitis
involves skin folds
Tx of diaper candidiasis?
topical antifungal agents:
clotrimazole cream first, apply barrier
cleanse gently, diaper free time
Can you tx diaper candidiasis with steroids?
NO
What is cradle cap? Presentation?
seborrheic dermatitis
Greasy, yellowish scales on scalp (#1), ear, face, diaper area.
Usually 3wks- 12mos of age
Tx of cradle cap?
conservative: emollient (petroleum jelly), softbaby brush
severe/refractory: topical steroid or ketoconazole
Epidemiology of impetigo? Types?
usually 2-5
bullous and non-bullous (MC)
presentation of non-bullous impetigo?
Papules vesicles thick, “honey-colored” crust w surrounding erythema, usually face & extremities
tx of imeptigo?
Mild: Mupirocin (Bactroban) topical antibiotic 3x a day for 5 days
More severe: Mupirocin ointment + PO antibiotic (Keflex) x 7 days
Pathogen involved in impetigo?
s. aureus, poss strep
