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PHA 581 > Peds: HEENT > Flashcards

Peds: HEENT Flashcards

1
Q

Bacterial Conjunctivitis:

  • presentation
  • pathogens
A

thick PURULENT ropy discharge
unilateral
eyes “crusted shut” in AM
+/- preauricular lymphadenopathy

HMSS
newborns: CHLAMYDIA TRACHOMATIS

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2
Q

Bacterial Conjunctivitis: treatment

A

infants: abx ointment
older: abx drops

**treat both eyes

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3
Q

Viral Conjunctivitis:

  • pathogen
  • presentation
A

adenovirus

conjunctival injection
watery discharge
bilateral
feels “gritty”

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4
Q

Viral Conjunctivitis: treatment

A

self limited

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5
Q

Allergic Conjunctivitis: presentation

A

EXTREMELY PRURITIC watery red eyes
bilateral
profuse watery discharge/tearing
+sneezing, dry cough, atopic dermatitis

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6
Q

Allergic Conjunctivitis: treatment

A

symptomatic (olopatadine if >2yo)

reduce exposure

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7
Q

Preseptal (Periorbital) Cellulitis:

  • what is it
  • presentation
A

infx ant to orbital septum

erythematous edematous eyelids
pain
mild fever
NORMAL vision, EOMs

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8
Q

Preseptal (Periorbital) Orbital Cellulitis: treatment

A

oral/systemic abx

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9
Q

Orbital Cellulitis:

  • what is it
  • complications
  • MC population
A

infx posterior to orbital septum

acute ischemic optic neuropathy
cerebral abscess

MC in children

almost always associated w/ rhinosinusitis/sinus infx

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10
Q

Orbital Cellulitis: presentation

A 
\+/- fever
lid swelling + erythema
visual disturbances/dec vision
PAIN W/ EOMS
PROPTOSIS
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11
Q

Orbital Cellulitis: diagnosis

A

CT or MRI

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12
Q

Orbital Cellulitis: treatment

A

EMERGENCY
ophthalmology consult
oral/IV abx
+/- drainage

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13
Q

Kawasaki Disease:

  • aka
  • what is it
  • MC population
A

aka mucocutaneous LN syndrome

widespread inflammation of med-sm arteries

boys
inc risk w/ asian ancestry
<5yo

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14
Q

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

A

Kawasaki disease

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15
Q

Kawasaki Disease: diagnostic criteria

A 
prolonged fever 
B bright red nonexudative conjunctivitis
mucositis (cracked lips, strawberry tongue, pharyngeal erythema)
rash + desquamation (starts in perineum)
cervical lymphadenopathy
edema, redness of palms/soles
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16
Q

Kawasaki Disease: management

A

IVIG + ASA (most effective w/in 7-10d)

echocardiogram (0, 2, 6wks)

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17
Q

Kawasaki Disease: complications

A

coronary artery aneurysms
myocarditis
arrythmias

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18
Q

Corneal Abrasion: what is it

A

loss of SF layer of corneal cells

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19
Q

Corneal Abrasion: presentation

A 
red eye
watery discharge
blephorospasm
sev ocular pain
fussy/irritable
rubbing at eye
photophobia (squinting)
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20
Q

Corneal Abrasion: diagnosis

A

fluorescein stain + woods lamp

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21
Q

Corneal Abrasion: treatment

A

abx ointment (erythromycin)
recheck in 24-48hrs
patch affected eye?

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22
Q

Dacrostenosis: what is it

A

nasolacrimal duct obstruction

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23
Q

Dacrostenosis: presentation

A

chronic/intermittent tearing
debris on lashes
palpable nasolacrimal sac
+/- discharge

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24
Q

Dacryostenosis: treatment

A

lacrimal sac massage 2-3x/d
observation

> 6mo: refer (lacrimal probing)

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25
Q

Dacryocystitis:

  • what is it
  • pathogens
A

secondary infx of dacryostenosis

infx of nasolacrimal sac –> erythema, edema

S. aureus, S. pneumoniae, S. pyogenes, S. viridans, M. catarrhalis & Haemophilus species

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26
Q

Dacryocystitis: presentation

A

swelling
erythema/edema
bluish hue

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27
Q

Dacryocystitis: treatment

A

PO/IV abx

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28
Q

Amblyopia:

  • what is it
  • classification
A

functional reduction in visual acuity

unilateral

associated w/ impaired/absent fine depth perception

classified based on cause

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29
Q

Strabismus:

  • what is it
  • classification
A

“lazy eye”
misalignment of eyes

classified based on direction of deviation, frequency

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30
Q

Strabismus: risk factors

A

positive FH

low birth weight (prematurity)

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31
Q

Acute Otitis Media: presentation

A

ERYTHEMATOUS BULGING TM
MIDDLE EAR EFFUSION
if perforation: EXUDATE

+/- fever
ear pain
concurrent/following URI

infant: poor feeding, pulling ear, batting at head, poor sleeping, fussiness
older: c/o ear pain, c/o sinus tenderness, HA, dec hearing, c/o dizziness

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32
Q

Acute Otitis Media: treatment

A

<2yr: abx

> 2yr:

  • 48hr observation (healthy, unilateral, mild sx, no drainage)
  • abx (toxic, sx>48hr, fever, bilateral, otorrhea)

**abx: AMOX 80-90mg/kg/d x 10d

**recurrent: refer to ENT for myringotomy w/ tympanostomy tubes

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33
Q

Acute Otitis Media: tympanostomy tube otorrhea: treatment

A

otic FQ abx drops (+/- corticosteroid)

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34
Q

Serous Otitis Media: what is it

A

middle ear effusion w/out infx

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35
Q

Serous Otitis Media: presentation

A 
pain
pressure
popping
dec hearing
disequilibrium

TM: grey, shiny, normal/retracted, immobile, bubbles/fluid

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36
Q

Serous Otitis Media: risk factors

A 
follow resolution of undiagnosed AOM
FH of OM
bottle feeding
daycare attendance
tobacco exposure
reflux?
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37
Q

Serous Otitis Media: treatment

A

self limited (can take up to 12wks)

refer if persistent (>3mo)

DO NOT USE STEROIDS/ANTIHISTAMINES/DECONGESTANTS

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38
Q

Otitis Externa: presentation

A

significant ear pain
unilateral
malodorous discharge/exudate
tragal tenderness

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39
Q

Otitis Externa:

  • treatment
  • prevention
A 
abx drops (ciprodex)
if perforation: FQ

50/50 rubbing alcohol + white vinegar

40
Q

Nasal/Aural Foreign Bodies: presentation

A

asymptomatic –> congestion, foul smelling/purulent/bloody discharge, periorbital cellulitis

41
Q

Nasal/Aural Foreign Bodies: management

A

removal (tiny forceps, superglue/cotton swab, mouth to mouth)

**aural: attempt irrigation first (if TM intact)

42
Q

Allergic Rhinitis: presentation

A 
Sneezing
Rhinorrhea
Nasal congestion
Scratchy sore throat
Pruritus
Tearing 
Cough
Snoring
Sniffles
Anosmia
Headache
Fatigue 
allergic shiners
nasal crease (allergic salute)
pale, bluish, boggy mucosa
clear rhinorrhea
pharyngeal cobblestoning
43
Q

Allergic Rhinitis: management

A

intranasal steroid
oral/intranasal antihistamine
trigger avoidance
immunotherapy

44
Q

Sinusitis: presentation

A 
SX > 10-14D W/O IMPROVEMENT
purulent nasal discharge
sinus pain
\+/- fever
halitosis
headache
dental pain
45
Q

Sinusitis: MC pathogen

A

S pneumoniae or H flu

46
Q

Sinusitis: diagnosis

A

clinical

if chronic:

  • water’s view xray
  • culture
  • CT
47
Q

Sinusitis: treatment

A 
abx (AUG or AMOX)
sx therapy (irrigation, analgesics, humidifier)
48
Q

With recurrent/severe sinusitis, what other disorder needs to be considered?

A

cystic fibrosis

49
Q

Pharyngitis:

  • MC etiology
  • presentation
A

viral

red throat
congestion
fever
fatigue
swollen cervical nodes

**adenovirus: B conjunctivitis

50
Q

Pharyngitis: treatment

A

education
analgesics
fluids
rest

51
Q

Pharyngitis: EBV:

  • aka
  • MC population
  • incubation period
A

infectious mononucleosis

adolescents

4-8wks

52
Q

Pharyngitis: EBV: presentation

A 
EXUDATIVE TONSILLITIS
CERVICAL LYMPHADENOPATHY
fatigue
malaise
headache
fever
SPLENOMEGALY
53
Q

Pharyngitis: EBV: diagnosis

A

fingerstick (monospot)

EBV titer

54
Q

Pharyngitis: EBV: treatment

A

spleen precautions (6-8wks)
monitor fluids/airway
analgesics
+/- steroids

**AMOX –> rash

55
Q

Pharyngitis: GABHS: presentation (>3yo)

A 
abrupt onset
fever
sore throat
HA
NAUSEA
abd pain
RASH
56
Q

Pharyngitis: GABHS: presentation (<3yo)

A

nasal congestion
low fever
ant cervical lymphadenopathy

57
Q

Pharyngitis: GABHS: physical exam

A 
exudative tonsillitis 
palatal petechiae
\+/- scarlatiniform rash
halitosis
coated tongue
58
Q

Pharyngitis: GABHS: diagnosis

A 
rapid strep antigen test 
throat culture (gold standard)
59
Q

Pharyngitis: GABHS: treatment

A

abx (PCN VK)
analgesics
fluids
reduce transmission

60
Q

Pharyngitis: GABHS: Acute Rheumatic Fever:

  • course
  • age group
A

2-3wks post strep infx

5-15yo

61
Q

Pharyngitis: GABHS: Acute Rheumatic Fever: Jones’ Criteria

A

(2maj or 1maj 2min)

Major criteria:
Migrating polyarthritis (large joints)
Carditis and valvulitis
Chorea (involuntary movements, muscular weakness, and emotional disturbances)
Erythema marginatum (erythematous rash, nonpruritic, spares the face)
Subcutaneous nodules (on bony prominences, nonpainful)

Minor criteria:
Arthralgia
Fever
Elevated ESR or CRP
Prolonged PR interval
62
Q

What is the #1 cause of acquired valve disease worldwide?

A

rheumatic heart disease

63
Q

Pharyngitis: GABHS: Acute Rheumatic Fever: diagnosis

A

ASO titer

64
Q

Pharyngitis: GABHS: Acute Rheumatic Fever: treatment

A

abx (AMOX)
anti inflammatories (ASA)
evaluate for carditis

65
Q

Pharyngitis: Post Streptococcal Glomerulonephritis: what is it

A

inflammation of glomeruli secondary to deposition of immune complexes

66
Q

Pharyngitis: Post Streptococcal Glomerulonephritis: presentation

A 
edema
hematuria (TEA COLORED URINE)
proteinuria
HTN
Na and water retention
67
Q

Pharyngitis: Post Streptococcal Glomerulonephritis: diagnosis

A

ASO titer

68
Q

Pharyngitis: Post Streptococcal Glomerulonephritis: treatment

A 
self limited (resolves wks-mos)
maybe diuretics
69
Q

Peritonsillar abscess:

  • pathogen
  • age group
A

S pyogenes, polymicrobial

MC in older/adolescents

70
Q

Peritonsillar abscess: presentation

A 
difficulty/pain swallowing
DROOLING
dec oral intake
change in voice (HOT POTATO/MUFFLED)
respiratory distress
neck swelling/lymphadenopathy
TRISMUS
71
Q

Peritonsillar abscess: diagnosis

A

clinical (deviated uvula, tonsilar edema)
CT w/ constrast
aspiration

72
Q

Peritonsillar abscess: management

A

airway
drainage
high dose IV abx

73
Q

Coxsackie Virus:

  • aka
  • epidemiology
A

hand food and mouth

<5yo
daycare outbreaks

74
Q

Coxsackie Virus: presentation

A

oral lesions - herpangina (tongue, palate, tonsillar pillars)
maculopapular/vesicular rash (hands, feet)

low fever
refusal to eat/drink
drooling
sore throat 
HA
75
Q

Coxsackie Virus: treatment

A

supportive

popsicles

76
Q

Herpetic Gingivostomatitis:

  • pathogen
  • presentation
A

HSV 1

ulcerative lesions (gingiva, mucous membranes, perioral) – bleed

3-4d prodrome
fever
sleeplessness
headache

77
Q

Herpetic Gingivostomatitis: treatment

A

oral acyclovir
NSAIDs/APAP
hydration

78
Q

Measles (Rubeola): prodrome

A

fever, malaise, anorexia
–>
CONJUNCTIVITIS, CORYZA, COUGH

KOPLIK SPOTS (48hrs before rash)

79
Q

Measles (Rubeola): exanthem

A

maculopapular, blanching rash (FACE –> NECK, TRUNK, EXTREMITIES)

80
Q

Measles (Rubeola):

  • complication
  • diagnosis
A

encephalitis

IgM assay

81
Q

Measles (Rubeola): treatment

A

prevent spread

supportive therapy

82
Q

Mumps:

  • incubation
  • presentation
A

14-18d

2-3d prodrome

PAROTITIS (U–>B)
loss of angle of jaw bone

83
Q

Mumps: complications

A 
ORCHITIS (fever, testicular pain/swelling)
OOPHORITIS 
encephalitis
sensorineural hearing loss
neurologic syndromes
84
Q

Mumps: treatment

A

supportive

prevent transmission

85
Q

Rubella (German Measles):

presentation

A

fever
postauricular + occipital adenopathy
acute onset maculopapular rash (face first)

86
Q

Rubella (German Measles): consequences

A 
congenital rubella syndrome:
hearing loss
mental retardation
CV defects
ocular defects
retarded growth 
purpuric "blueberry muffin" rash
jaundice 
thrombocytopenia
deafness
87
Q

Rubella (German Measles):

treatment

A

supportive
prevent transmission
vaccinate

88
Q

Diaper Candidiasis: presentation

A

beefy red erythema w/ satellite lesions

involves SKIN FOLDS

89
Q

Diaper Candidiasis: treatment

A 
topical antifungals (clotrimazole, nystatin)
barrier ointment
gentle cleansing
diaper free time
NO STEROIDS
90
Q

Cradle Cap:

  • aka
  • presentation
  • course
A

seborrheic dermatitis

greasy yellow scales on scalp (also ear, face, diaper area)

3wk-12mo

91
Q

Cradle Cap: treatment

A

emollient
soft baby brush/toothbrush (removes gently)

sev, ref: topical steroid, ketoconazole shampoo

92
Q

Impetigo:

  • age group
  • MC pathogen
A

2-5yo

S aureus

93
Q

Impetigo: non bullous presentation

A

MC

papules –> vesicles –> thick HONEY COLORED CRUST w/ surrounding erythema (face, extremtities)

94
Q

Impetigo: bullous presentation

A

flaccid bullae w/ clear yellow fluid
rupture –> brown crust
(trunk)

95
Q

Impetigo: treatment

A

mild: mupirocin topical
sev: mupirocin ointment + PO abx (keflex)

PHA 581 (6 decks)

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