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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
How do you treat dacryocystitis
Mild: PO abx +/- topical abx Severe: IV abx after culture and staining
26
What are possible causes of acute otitis media
eustachian tube dysfunction bacterial infection viral infection allergy
27
What are Sx of
+/- 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
28
On PE of AOM you will find
erythematous, bulging TM and middle ear effusion | If TM is perforated, canal will have exudate
29
How do you treat acute otitis media
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
30
What antibiotics can you use for acute otitis media
1: Amoxicilli 80-90 mg/kg x 10 days (Use Cefdinir if allergic)
31
What is serous otitis media
Otitis media w/ middle ear effusion WITHOUT infection | causes pain, pressure, "popping", decreased hearing, disequilibrium
32
On PE of serous otitis media you will see
TM grey and shiny, normal or retracted | TM NOT red!
33
How do you diagnose serous otitis media
clinically! Can do pneumatic otoscopy (TM will be mobile) Tympanometry Bubbles/fluid level may be visible
34
RF for serous otitis media include
FHx bottle feeding daycare exposure to smoke
35
How do you treat serous otitis media
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
What is otitis externa
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
On otitis externa exam you will find
Tragal tenderness | exudate in ear canal
38
How do you treat otitis externa
Antibiotic drops (Cipro+dexa) Hydrocortisone to decrease swelling Prevent by using 50/50 rubbing alcohol and white vinegar after swimming
39
Later symptoms of a nasal FB include
congestion foul smelling/purulent/bloddy nasal discharge periorbital cellulitis if severe
40
How do you remove foreign bodies
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
What are Sx of allergic rhinitis
``` sneezing rhinorrhea nasal congestion scratchy sore throat pruritis tearing cough sniffles snoring anosmia HA fatigue ```
42
Allergic rhinitis triggers include
``` new pets outdoor activities seasonality cigarette smoke in home Atopic triad: allergies, asthma, atopic dermatitis ```
43
On PE with allergic rhinitis you may find
``` allergic shiners nasal crease (allergic salute) pale, blue, boggy nasal mucosa clear rhinorrhea cobblestoning on posterior pharynx ```
44
How do you treat allergic rhinitis
-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
When do sinuses develop
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
What are Sx of sinusitis
``` 10-14 days of Sx without improvement (can overlap viral URI Sx) Purulent nasal d/c sinus pain +/- fever halitosis HA dental pain ```
47
How can you tell if sinusitis is viral
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
What causes sinusitis
MC bacterial cause is STREP pneumo! Also H influenza and M catarrhalis -If recurrent or severe, consider cystic fibrosis
49
If sinusitis is chronic (>30 days), what diagnostic imaging is done
Water's view radiograph to r/o CF Can do a culture (ENT) May do CT but not likely 2/2 radiation
50
How do you treat sinusitis
Start w/ intranasal saline irrigation, analgesics, and a humidifier IF Sx >10-14 days, Augmentin is first like (45 mg/kg BID)
51
What causes viral pharyngitis (most common)
Adenovirus! | Leads to red throat, congestion, fever, fatigue, swollen cervical lymph nodes
52
How do you treat viral pharyngitis
Educate parents analgesics fluids rest
53
What is a more common cause of pharyngitis in adolescents
EBV (infectious mono) | Presents with exudative tonsils, cervical LAD, splenomegaly, fatigue and malaise, HA, fever
54
How do yuo diagnose and treat infectious mono (pharyngitis)
``` 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
If it is mono but you treat for strep...
You will develop a rash from the Penicillin!
56
What causes Strep pharyngitis
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
On PE for Strep pharyngitis you may note
``` Exudative tonsils Enlarged tender anterior cervical LAD Palatal petechiae +/- Scarlet fever rash Halitosis Coated tongue ```
58
How do you diagnose and treat Strep
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
What is a major complication of GABHS
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
What is Major jones criteria
``` Migrating polyarthritis Carditis and valvulitis Chores Erythema marginatum Subcutaneous nodes (not painful) ```
61
What is Minor jones criteria
Arthralgia fever elevated ESR/CRP prolonged PR
62
How do you diagnose and treat acute rheumatic fever
ASO titers! -(Like pharyngitis) Amoxicillin, Aspirin Evaluate for carditis
63
What is post-strep glomerulonephritis
Inflammation of glomeruli 2/2 deposit of immune complexes | Leads to *Edema, hematuria, proteinuria, HTN
64
How do you diagnose and treat PGN
ASO titers! Self limited (weeks-months) May need diuretics if HTN and edema persist
65
What is a peritonsillar abscess
progression of bacterial tonsilitis caused by Strep pyogenes (may be polymicrobial)
66
Sx of a peritonsilar abscess include
``` Dysphagia, pain with swallowing drooling w/ decreased oral intake *Hot potato voice (muffled) Respiratory distress Neck swelling Trismus CAUTION: can look like epiglottitis! ```
67
How do you Diagnose and treat a peritonsillar abscess
Clinically (uvula deviates, edema), CT w/ contrast, aspiration -Airway! surgical drainage, antibiotics
68
Coxsackie virus causes
``` 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
How do you treat Coxsackie virus
Supportive (popsicles) | *contagious, so keep out of daycare uneil bumps crust over and become flat
70
What is herpetic gingivostomatitis
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
How do you treat herpetic gingivostomatitis
Acyclovir oral if Sx <4 days and dehydrated NSAIDs/APAP for pain **Hydration!
72
What are symptoms of the measles
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
Measles can lead to
encephalitis and death! | Monitor for neuro Sx, neck stiffness, and behavior changes
74
How do you diagnose and treat measles
IgM assay | Prevent spread! Supportive therapy
75
What are Sx of Mumps
Parotitis (unilateral, can spread bilaterally) Loss of angle of jawbone Orchitis (fever, severe testicular pain, swelling) Oophoritis Permanent hearing loss
76
How do you treat mumps
Supportive, prevent transmission
77
Rubella causes
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
How do you treat Rubella
Supportive, prevent spread
79
What is diaper candidiasis
Candida albicans causing beefy red erythema with satellite lesions, mainly in skin folds (axilla, diaper)
80
How do you treat diaper candidiasis
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
What is Cradle Cap
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
How do you treat cradle cap
``` Apply emollient (petroleum jelly), use a soft baby brush to gently remove from scalp If severe or refractory, topical steroid or ketoconazole shampoo ```
83
What are the types of impetigo
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
How do you treat Impetigo
Mupirocin (bactroban) topical TID x 5 days | If severe or over larger area, Use Mupirocin ointment + Keflex x 7 days
85
Strep can cause
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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