Peds HEENT Flashcards by Mariah Cholley

What are characteristics of bacterial conjunctivitis?

Thick, purulent, ropy discharge

Starts unilateral

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What pathogen is MC in bacterial conjunctivitis?

Chlamydia trachomatis

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What pathogen is MC in viral conjunctivitis?

Adenovirus (1 of the primary causes of colds/URI)

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What are characteristics of viral conjunctivitis?

Watery discharge
Bilateral
Feels “gritty”

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What are characteristics of allergic conjunctivitis?

Extremely pruritic

Profuse watery discharge/tearing

Bilateral

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How do you treat symptomatic pts w/ allergic conjunctivitis?

Olopatadine in children ≥ 2

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What are characteristics of periorbital cellulitis?

Preseptal (anterior to orbital septum)

Vision & EOMs normal

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What are the 2 MC pathogens involved in periorbital cellulitis?

S. aureus & S. pyogenes

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How do you treat periorbital cellulitis?

Oral/systemic abx

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What are characteristics of orbital cellulitis?

Posterior to orbital septum

Pain w/ EOMs, proptosis

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What are 2 complications of orbital cellulitis?

Acute ischemic optic neuropathy

Cerebral abscess

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How do you dx & tx orbital cellulitis?

CT or MRI
Emergent optho consult
IV abx +/- drainage

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What is the leading cause of acquired heart disease in US children?

Kawasaki disease

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What is kawasaki disease?

Widespread inflammation of medium & small arteries, including coronary arteries

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What are the diagnostic criteria for kawasaki disease?

Conjunctivitis: bilteral, non exudative

Mucositis: cracked lips, strawberry tongue, pharyngeal erythema

Polymorphous rash: skin peels

Lymphadenopathy

Extremity changes: edema

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How do you treat KD?

IVIG + ASA (80-100mg)

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What are complications of KD?

CV: coronary artery aneurysms

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What is a corneal abrasion?

Loss of SF layer of corneal cells

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What are the sx of a corneal abrasion?

Severe ocular pain*
Blephorospasm
Squinting, photophobia
Rubbing at eye

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How do you dx a corneal abrasion?

Fluorescein stain, Wood’s lamp

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How do you treat a corneal abrasion?

If FB –> optho referral

Erythromycin ointment, recheck in 24-48hrs

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What is the MC cause of persistent tearing & eye discharge in infants/children?

Dacryostenosis (nasolacrimal duct obstruction)

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How do you treat dacryostenosis?

Lacrimal sac massage in downward direction 2-3x/day

Refer if sx persist past 6mos

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What is dacryocystitis?

Secondary infection of dacryostenosis

Infection of nasolacrimal sac –> erythema & edema

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What pathogens cause dacrocystitis?

Bacteria that colonize URT S. aureus, S. pneumo, S. pyogenes, S. viridans, M. catarrhalis, Haemophilus

How do you treat dacryocystitis?

If severe --> IV abx If mild --> PO + topical abx

What causes AOM?

Allergies Viral or bacterial infection Eustachian tube dysfxn

What are sx of AOM in infants?

Fever | Poor feeding or sleeping, pulling ear, fussy

What are sx of AOM in older children?

Ear pain Sinus tenderness HA, dizziness Decreased hearing

What does AOM look like on PE?

Erythematous, bulging TM & MEE If perforated: canal w/ exudate

How do you treat AOM from birth to 2yo?

Immediately w/ abx | Can treat w/ observation in 6mos-2yrs if mild sx

How do you treat AOM in children ≥ 2yo who appear toxic vs those w/ mild sx?

If toxic: immediately w/ abx If mild: initial observation or treat

What med is 1st line in AOM?

Amoxicillin 80-90mg/day x 10 days

How do you treat OM in those w/ PE tubes?

Tympanostomy tube otorrhea | FQ drops if mild

What is serous OM?

MEE w/out infection

What are sx of serous OM?

Pain, pressure, "popping" Decreased hearing Disequilibrium

What are RFs of serous OM?

``` Undiagnosed AOM FH of OM Bottle feeding Daycare Exposure to smoke ```

What are sx & PE findings of otitis externa (swimmer's ear)?

Ear pain, unilateral Malodorous discharge Tragal tenderness

How do you treat OE?

Abx drops w/ steroids, hydrocortisone

How do you prevent swimmer's ear?

Rubbing alcohol & white vinegar after swimming

What is the atopic triad?

Seen in allergic rhinitis - Allergies - Asthma - Eczema

What does allergic rhinitis look like on PE?

``` Allergic shiners Nasal crease Pale, blue/boggy mucosa Clear rhinorrhea Cobblestone pharynx ```

How do you treat allergic rhinitis?

Intranasal steroid sprays | Antihistamines

What are s/s of sinusitis?

``` > 10-14 days of sx Purulent nasal discharge Sinus pain +/- fever HA Halitosis, dental pain ```

What is the MC pathogen in sinusitis?

S. pneumo

How do you treat sinusitis?

1st line = Augmentin BID or | Amoxicillin BID

What are characteristics of EBV?

Exudative tonsillitis Cervical lymphadenopathy Splenomegaly Incubation = 4-8wks

How do you treat EBV?

Spleen precautions 6-8wks | No contact sports

What are sx of GABHS?

Fever, ST Nausea, abd pain Rash

What does GABHS look like on PE?

``` Exudative tonsillitis Enlarged lymph nodes Palatal petechiae Halitosis, coated tongue +/- scarlatiniform rash ```

How do you dx GABHS? What is the gold standard?

Rapid strep antigen Gold = culture

What is the gold standard tx for GABHS?

Penicillin BID x 10 days

What is the alternative tx for GABHS?

Amoxicillin BID x 10 days

How do you treat GABHS if patient allergic to PCN?

1st gen cephalosporin (cephalexin) Clindamycin Macrolides: azithro, clarithro

What is the "major criteria" for acute rheumatic fever?

``` Migrating polyarthritis Carditis & valvulitis Chorea Erythema marginatum Subcutanous nodules ```

What is the "minor criteria" for ARF?

Arthralgia Fever Elevated ESR or CRP Prolonged PR interval

What is considered high likelihood of ARF?

2 major OR | 1 major & 2 minor

How do you dx ARF & PGN?

ASO titers

How do you treat ARF?

Amoxicillin | ASA

What are sx of PGN?

Edema (#1) Hematuria, proteinuria HTN

What are sx of coxsackie virus (hand, foot, & mouth)?

Oral lesions, ST Maculopapular or vesicular rash Fever, refuse to eat/drink

What is herpetic gingivostomatitis?

HSV1 Ulcerative lesions of the gingiva & MMs that bleed if disturbed

How do you treat herpetic gingivostomatitis?

Acyclovir NSAIDs Hydration

What are the prodrome sx of measles?

Conjunctivitis, coryza, cough Koplik's spots (48hrs before rash)

What are exanthem sx of measles?

Maculopapular, blanching rash Face --> neck, trunk, extremities

How do you dx measles?

IgM assay

What is a complication of the measles?

Encephalitis

What are characteristics of mumps?

Incubation = 14-18days Parotitis Unilateral, but can spread to contralateral parotid gland Orchitis Oophoritis

What are sx of rubella?

Fever w/ postauricular & occipital adenopathy Maculopapular rash: starts on face

How do you treat impetigo?

Mild --> mupirocin topical Severe --> Mupirocin ointment + PO abx