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Summer Disciplines 2 > Peds HEENT > Flashcards

Peds HEENT Flashcards

1
Q

What causes bacterial conjunctivitis

A

Newborns: Chlamydia trachomatis!!

Strep pneumo, H influenza, M cattarhalis, Staph aureus

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2
Q

What are Sx of bacterial conjunctivitis

A

Thick, purulent, ropy discharge
Starts unilateral
eyelids “crusted shut” in the AM
+- preauricular LAD

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3
Q

How do you treat bacterial conjunctivitis

A

Infant: Abx ointment
Older: Abx drops (close eyes, put drop in corner, then have them blink
Treat BOTH eyes!
Ex abx are ofloxacin

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4
Q

What causes viral conjunctivitis

A

adenovirus (a primary URI pathogen)

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5
Q

What are Sx of viral conjunctivitis

A

Typically bilateral
injection, watery discharge
+/- URI symptoms and “gritty” feeling

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6
Q

How do you treat viral conjunctivitis

A

Self limited!

If they don’t have fever or URI Sx, they can go back to daycare

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7
Q

What are Sx of allergic conjunctivitis

A 
itchy, watery, red eyes
Extremely pruritic 
Commonly bilateral 
Profuse watery discharge/tearing 
Sx of allergic rhinitis (sneezing, dry cough, atopic dermatitis)
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8
Q

How do you treat allergic conjunctivitis

A

Reduce exposure to allergen

Olopatadine if 2+ y/o (antihistamine)

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9
Q

What is periorbital cellulitis

A

infection arising ANTERIOR to orbital septum
Mild, minimal complications, but can progress to orbital cellulitis
Arises form exogenous source (eyelid abrasion, hordeolum, chalazion, dacryocystitis, insect bite, etc.)

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10
Q

What are Sx of periorbital cellulitis

A

Erythematous and edematuos eyelids
pain
mild fever
** vision and EOM are normal!!

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11
Q

How do you treat periorbital cellulitis

A

Oral or systemic antibiotics

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12
Q

What is orbital cellulitis

A

infection POSTERIOR to orbital septum
can cause serious complications; acute ischemic optic neuropathy, cerebral abscess)
Associated with rhinosinusitis or sinus infection
MCC are staph aureus and strep

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13
Q

Sx or orbital cellulitis are

A

+/- fever
lid swelling and erythema
vision disturbance, decreased vision
**PAIN with EOM, proptosis!

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14
Q

How do you diagnose and treat orbital cellulitis

A

CT/MRI
Emergent Optho consult
IV antibiotics +/- drainage (surgical)

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15
Q

What is Kawasaki disease

A

widespread inflammation of medium and small arteries of unknown etiology
MC in winter and spring
transmissible to household contacts
M>W
Leading cause of acquired heart disease in U.S. Kids

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16
Q

On CBC, kawasaki disease may show

A

anemia and thrombocytosis

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17
Q

Kawasaki disease diagnostic criteria is

A

Fever + “cream”
Conjunctivitis (b/l red)
Rash (polymorphous. starts in perineum, skin peels and spreads)
Edema (hands and feet)
Adenopathy (cervical)
Mucositis (cracked lips, strawberry tongue)

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18
Q

How do you manage Kawasaki disease

A

IVIG + Aspirin (yes, even <7 y/o)
Most effective in first 7-10 days, so dont miss this!!
Reduces incidence of aneurysms
-Get a baseline ECG, then repeat at 2 and 6 weeks
*NO live vaccines w/in 11 months of IVIG**

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19
Q

What are complications of kawasaki disease

A

Coronary artery aneurysms= MI, sudden death
Myocarditis
arrhythmias
Highest risk are <1 and >9

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20
Q

What are Sx of a corneal abrasion

A 
red eye w/ watery discharge 
blephorospasm (tight lid closure) 
Severe ocular pain 
fussy baby, irritable toddler 
rubbing at eye 
Squinting
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21
Q

How do you diagnose and treat corneal abrasion

A 
Fluorescein stain and woods lamp (FB= optho referral) 
Abx ointment (erythromycin) and patch, recheck in 24-48 hours; if size does not decrease, refer to optho 
*NO patching if they wear contacts*
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22
Q

What is dacryostenosis

A

Nasolacrimal duct obstruction, MCC of persistent tearing and eye discharge in newborns
Causes chronic intermittent tearing, debris on lashes, but NO conjunctival irritation
Palpable nasolacrimal sac

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23
Q

How do you treat dacryostenosis

A

Lacrimal sac massage downwards 2-3x day (can use warm washcloth)
Obs
If persistent >6 months, refer to optho for lacrimal duct probing

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24
Q

What is dacryocystitis

A

Secondary infection of dacryostenosis caused by Staph aureus, strep pneumo/pyogenes/viridans, m catarrhalis, and H influenza
Causes swelling, erythema and edema over the lacrimal sac

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25
Q

How do you treat dacryocystitis

A

Mild: PO abx +/- topical abx
Severe: IV abx after culture and staining

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26
Q

What are possible causes of acute otitis media

A

eustachian tube dysfunction
bacterial infection
viral infection
allergy

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27
Q

What are Sx of

A

+/- fever, ear pain
Infant: poor feeding, pulling at ear, batting at head, poor sleeping, fussiness
Older: c/o ear pain, sinus tenderness, HA, decreased hearing, dizziness

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28
Q

On PE of AOM you will find

A

erythematous, bulging TM and middle ear effusion

If TM is perforated, canal will have exudate

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29
Q

How do you treat acute otitis media

A

0-2 yrs: Amoxicillin-or Augmentin-or Cefdinir
>2 y/o, unilateral, mild, no drainage: obs for 48 hrs
>2 y/o, toxic, Sx>48 hrs, T >102.2, b/l, otorrhea: Amoxicillin- or augmentin- or Cefdinir
Recurrent (>4x yr): refer to ENT for myringotomy w/ tympanostomy tubes
W/ PR tubes: Fluoroquinolone drops +/- steroid (Cipro + dexamethasone)- oral abx if severe

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30
Q

What antibiotics can you use for acute otitis media

A

1: Amoxicilli 80-90 mg/kg x 10 days (Use Cefdinir if allergic)

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31
Q

What is serous otitis media

A

Otitis media w/ middle ear effusion WITHOUT infection

causes pain, pressure, “popping”, decreased hearing, disequilibrium

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32
Q

On PE of serous otitis media you will see

A

TM grey and shiny, normal or retracted

TM NOT red!

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33
Q

How do you diagnose serous otitis media

A

clinically!
Can do pneumatic otoscopy (TM will be mobile)
Tympanometry
Bubbles/fluid level may be visible

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34
Q

RF for serous otitis media include

A

FHx
bottle feeding
daycare
exposure to smoke

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35
Q

How do you treat serous otitis media

A

self limited, but can take 12 weeks
If >3 months, refer to ENT for hearing eval
NO steroids, antihistamines, or decongestants in kids
If older, +/- affrin for 3 days max

36
Q

What is otitis externa

A

swimmer’s ear! MC in summer months 2/2 swimming frequently

Presents with unilateral ear pain, flaky, crusty, and malodorous discharge from ear canal

37
Q

On otitis externa exam you will find

A

Tragal tenderness

exudate in ear canal

38
Q

How do you treat otitis externa

A

Antibiotic drops (Cipro+dexa)
Hydrocortisone to decrease swelling
Prevent by using 50/50 rubbing alcohol and white vinegar after swimming

39
Q

Later symptoms of a nasal FB include

A

congestion
foul smelling/purulent/bloddy nasal discharge
periorbital cellulitis if severe

40
Q

How do you remove foreign bodies

A

Ear: Irrigate if TM intact
Nasal: tiny forceps, superglue on cotton swab, mouth to mouth (parent); avoid pushing further, refer to ENT if needed

41
Q

What are Sx of allergic rhinitis

A 
sneezing 
rhinorrhea 
nasal congestion 
scratchy sore throat 
pruritis 
tearing 
cough 
sniffles 
snoring 
anosmia 
HA
fatigue
42
Q

Allergic rhinitis triggers include

A 
new pets 
outdoor activities 
seasonality 
cigarette smoke in home 
Atopic triad: allergies, asthma, atopic dermatitis
43
Q

On PE with allergic rhinitis you may find

A 
allergic shiners 
nasal crease (allergic salute) 
pale, blue, boggy nasal mucosa 
clear rhinorrhea 
cobblestoning on posterior pharynx
44
Q

How do you treat allergic rhinitis

A

-Intranasal steroid spray: 2+ (Nasacort) 4+ (flonase)
-Antihistamines: Oral (diphenhydramine, Ceftrizine*) nasal (olopatadine, azelastine)
educate on trigger avoidance
-Immunotherapy: very effective long term Tx but weekly injections, expensive

45
Q

When do sinuses develop

A

Ethmoid and maxillary: birth
Frontal: 5-7 y/o
Sphenoid: 9 y/o
-Maxillary and frontal are MC for infx, but in kids you look at DURATION of Sx for a sinus infection

46
Q

What are Sx of sinusitis

A 
10-14 days of Sx without improvement (can overlap viral URI Sx) 
Purulent nasal d/c
sinus pain 
\+/- fever 
halitosis 
HA
dental pain
47
Q

How can you tell if sinusitis is viral

A

IF fever is present, it is early on (first 24 hours)

Sx peak around day 3-6 then improve. If 10+ days, think bacterial

48
Q

What causes sinusitis

A

MC bacterial cause is STREP pneumo!
Also H influenza and M catarrhalis
-If recurrent or severe, consider cystic fibrosis

49
Q

If sinusitis is chronic (>30 days), what diagnostic imaging is done

A

Water’s view radiograph to r/o CF
Can do a culture (ENT)
May do CT but not likely 2/2 radiation

50
Q

How do you treat sinusitis

A

Start w/ intranasal saline irrigation, analgesics, and a humidifier
IF Sx >10-14 days, Augmentin is first like (45 mg/kg BID)

51
Q

What causes viral pharyngitis (most common)

A

Adenovirus!

Leads to red throat, congestion, fever, fatigue, swollen cervical lymph nodes

52
Q

How do you treat viral pharyngitis

A

Educate parents
analgesics
fluids
rest

53
Q

What is a more common cause of pharyngitis in adolescents

A

EBV (infectious mono)

Presents with exudative tonsils, cervical LAD, splenomegaly, fatigue and malaise, HA, fever

54
Q

How do yuo diagnose and treat infectious mono (pharyngitis)

A 
Fingerstick (monospot), EBV titers 
Spleen percautions x 6-8 weeks (no contact sports, rough housing, etc.) 
Monitor fluids and airway 
Analgesics 
\+/- steroids 
**NO abx!
55
Q

If it is mono but you treat for strep…

A

You will develop a rash from the Penicillin!

56
Q

What causes Strep pharyngitis

A

GABHS
Presents in those >3 y/o as HA, nausea, rash, fever, sore throat, abd pain (NO cough)
If <3, nasal congestion, low grade fever, anterior cervical LAD

57
Q

On PE for Strep pharyngitis you may note

A 
Exudative tonsils 
Enlarged tender anterior cervical LAD 
Palatal petechiae 
\+/- Scarlet fever rash 
Halitosis 
Coated tongue
58
Q

How do you diagnose and treat Strep

A

Rapid strep antigen test; Throat culture in kids and teens w/ negative rapid strep; GOLD* throat culture
GOLD* Penicillin VK 25-50mg BID x 10 days
Amoxicillin x 10 days
Penicillin G benzathine IM one dose
-Allergic to penicillin; Cephalexin or Clindamycin TID x 10 days

59
Q

What is a major complication of GABHS

A

Acute rheumatic fever! happens 2-3 weeks s/p Strep clears which can lead to rheumatic heart disease in 10-20 years
Can be Dx if 2 major, or 1 major + 2 minor Jones criteria are present

60
Q

What is Major jones criteria

A 
Migrating polyarthritis 
Carditis and valvulitis 
Chores 
Erythema marginatum 
Subcutaneous nodes (not painful)
61
Q

What is Minor jones criteria

A

Arthralgia
fever
elevated ESR/CRP
prolonged PR

62
Q

How do you diagnose and treat acute rheumatic fever

A

ASO titers!
-(Like pharyngitis) Amoxicillin, Aspirin
Evaluate for carditis

63
Q

What is post-strep glomerulonephritis

A

Inflammation of glomeruli 2/2 deposit of immune complexes

Leads to *Edema, hematuria, proteinuria, HTN

64
Q

How do you diagnose and treat PGN

A

ASO titers!
Self limited (weeks-months)
May need diuretics if HTN and edema persist

65
Q

What is a peritonsillar abscess

A

progression of bacterial tonsilitis caused by Strep pyogenes (may be polymicrobial)

66
Q

Sx of a peritonsilar abscess include

A 
Dysphagia, pain with swallowing 
drooling w/ decreased oral intake 
*Hot potato voice (muffled) 
Respiratory distress 
Neck swelling 
Trismus 
CAUTION: can look like epiglottitis!
67
Q

How do you Diagnose and treat a peritonsillar abscess

A

Clinically (uvula deviates, edema), CT w/ contrast, aspiration
-Airway! surgical drainage, antibiotics

68
Q

Coxsackie virus causes

A 
Oral lesions (esp tongue and tonsils) 
Maculopapular rash on hands and feet 
Low grade fever 
refusal to eat or drink 
drooling 
sore throat 
HA 
-Peeling, desquamation, loss of finger or toe nails (normal! indicates infection leaving your body)
69
Q

How do you treat Coxsackie virus

A

Supportive (popsicles)

*contagious, so keep out of daycare uneil bumps crust over and become flat

70
Q

What is herpetic gingivostomatitis

A

Primary HSV-1 infection causing ulcerative lesions of gingiva abd mucous membranes
3-4 day prodrome followed by fever, sleeplessness, HA, and bleeding lesions if disturbes

71
Q

How do you treat herpetic gingivostomatitis

A

Acyclovir oral if Sx <4 days and dehydrated
NSAIDs/APAP for pain
**Hydration!

72
Q

What are symptoms of the measles

A

Prodrome: fever, malaise, anorexia, *Conjunctivitis + Coryza + Cough
Koplik spots (white elevations opposite molars 48 hours B4 rash)
Maculopapular rash starting on face, then neck, trunk, and extremities

73
Q

Measles can lead to

A

encephalitis and death!

Monitor for neuro Sx, neck stiffness, and behavior changes

74
Q

How do you diagnose and treat measles

A

IgM assay

Prevent spread! Supportive therapy

75
Q

What are Sx of Mumps

A

Parotitis (unilateral, can spread bilaterally)
Loss of angle of jawbone
Orchitis (fever, severe testicular pain, swelling)
Oophoritis
Permanent hearing loss

76
Q

How do you treat mumps

A

Supportive, prevent transmission

77
Q

Rubella causes

A

Maculopapuar rash that starts on face and disappears in 3 days
Fever
occipital adenopathy
-Can lead to congenital rubella syndrome (hearing loss, mental retardation, blueberry muffin rash at birth, jaundice, ocular defects)

78
Q

How do you treat Rubella

A

Supportive, prevent spread

79
Q

What is diaper candidiasis

A

Candida albicans causing beefy red erythema with satellite lesions, mainly in skin folds (axilla, diaper)

80
Q

How do you treat diaper candidiasis

A

Topical antifungals; Clotrimazole cream FIRST, then barrier ointment
Clean with plain warm water and very mild soap, may pat dry
Diaper free time as much as possible
NO steroids

81
Q

What is Cradle Cap

A

Seborrheic dermatitis! Occurs mostly in 3 wk-12 mo. May be caused by immature oil glands _ Malassezia furfur
Greasy, yellow scales on scalp, ear, face, and diaper area

82
Q

How do you treat cradle cap

A 
Apply emollient (petroleum jelly), use a soft baby brush to gently remove from scalp 
If severe or refractory, topical steroid or ketoconazole shampoo
83
Q

What are the types of impetigo

A

Non-bullous (MC): papules, honey colored crusts w/ surrounding erythema to face and extremities
Bullous: flaccid bullae w/ clear fluid. When they rupture they leave a thin brown crust on truck
-Both are caused by Staph aureus, sometimes strep

84
Q

How do you treat Impetigo

A

Mupirocin (bactroban) topical TID x 5 days

If severe or over larger area, Use Mupirocin ointment + Keflex x 7 days

85
Q

Strep can cause

A

red, irritated rash in the vagina and peri-rectal area, with white-yellow discharge
Suspect this if it is not treated with anti-fungals (from suspicion of candida)

Summer Disciplines 2 (8 decks)

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