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
2
Q
Bacterial Conjunctivitis: treatment
A
infants: abx ointment
older: abx drops
**treat both eyes
3
Q
Viral Conjunctivitis:
- pathogen
- presentation
A
adenovirus
conjunctival injection
watery discharge
bilateral
feels “gritty”
4
Q
Viral Conjunctivitis: treatment
A
self limited
5
Q
Allergic Conjunctivitis: presentation
A
EXTREMELY PRURITIC watery red eyes
bilateral
profuse watery discharge/tearing
+sneezing, dry cough, atopic dermatitis
6
Q
Allergic Conjunctivitis: treatment
A
symptomatic (olopatadine if >2yo)
reduce exposure
7
Q
Preseptal (Periorbital) Cellulitis:
- what is it
- presentation
A
infx ant to orbital septum
erythematous edematous eyelids
pain
mild fever
NORMAL vision, EOMs
8
Q
Preseptal (Periorbital) Orbital Cellulitis: treatment
A
oral/systemic abx
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
10
Q
Orbital Cellulitis: presentation
A
\+/- fever lid swelling + erythema visual disturbances/dec vision PAIN W/ EOMS PROPTOSIS
11
Q
Orbital Cellulitis: diagnosis
A
CT or MRI
12
Q
Orbital Cellulitis: treatment
A
EMERGENCY
ophthalmology consult
oral/IV abx
+/- drainage
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
14
Q
What is the leading cause of acquired heart disease in children in the US?
A
Kawasaki disease
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
16
Q
Kawasaki Disease: management
A
IVIG + ASA (most effective w/in 7-10d)
echocardiogram (0, 2, 6wks)
17
Q
Kawasaki Disease: complications
A
coronary artery aneurysms
myocarditis
arrythmias
18
Q
Corneal Abrasion: what is it
A
loss of SF layer of corneal cells
19
Q
Corneal Abrasion: presentation
A
red eye watery discharge blephorospasm sev ocular pain fussy/irritable rubbing at eye photophobia (squinting)
20
Q
Corneal Abrasion: diagnosis
A
fluorescein stain + woods lamp
21
Q
Corneal Abrasion: treatment
A
abx ointment (erythromycin)
recheck in 24-48hrs
patch affected eye?
22
Q
Dacrostenosis: what is it
A
nasolacrimal duct obstruction
23
Q
Dacrostenosis: presentation
A
chronic/intermittent tearing
debris on lashes
palpable nasolacrimal sac
+/- discharge
24
Q
Dacryostenosis: treatment
A
lacrimal sac massage 2-3x/d
observation
> 6mo: refer (lacrimal probing)
25
Dacryocystitis:
- what is it
- pathogens
secondary infx of dacryostenosis
infx of nasolacrimal sac --> erythema, edema
S. aureus, S. pneumoniae, S. pyogenes, S. viridans, M. catarrhalis & Haemophilus species
26
Dacryocystitis: presentation
swelling
erythema/edema
bluish hue
27
Dacryocystitis: treatment
PO/IV abx
28
Amblyopia:
- what is it
- classification
functional reduction in visual acuity
unilateral
associated w/ impaired/absent fine depth perception
classified based on cause
29
Strabismus:
- what is it
- classification
"lazy eye"
misalignment of eyes
classified based on direction of deviation, frequency
30
Strabismus: risk factors
positive FH
| low birth weight (prematurity)
31
Acute Otitis Media: presentation
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
32
Acute Otitis Media: treatment
<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
33
Acute Otitis Media: tympanostomy tube otorrhea: treatment
otic FQ abx drops (+/- corticosteroid)
34
Serous Otitis Media: what is it
middle ear effusion w/out infx
35
Serous Otitis Media: presentation
```
pain
pressure
popping
dec hearing
disequilibrium
```
TM: grey, shiny, normal/retracted, immobile, bubbles/fluid
36
Serous Otitis Media: risk factors
```
follow resolution of undiagnosed AOM
FH of OM
bottle feeding
daycare attendance
tobacco exposure
reflux?
```
37
Serous Otitis Media: treatment
self limited (can take up to 12wks)
refer if persistent (>3mo)
DO NOT USE STEROIDS/ANTIHISTAMINES/DECONGESTANTS
38
Otitis Externa: presentation
significant ear pain
unilateral
malodorous discharge/exudate
tragal tenderness
39
Otitis Externa:
- treatment
- prevention
```
abx drops (ciprodex)
if perforation: FQ
```
50/50 rubbing alcohol + white vinegar
40
Nasal/Aural Foreign Bodies: presentation
asymptomatic --> congestion, foul smelling/purulent/bloody discharge, periorbital cellulitis
41
Nasal/Aural Foreign Bodies: management
removal (tiny forceps, superglue/cotton swab, mouth to mouth)
**aural: attempt irrigation first (if TM intact)
42
Allergic Rhinitis: presentation
```
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
Allergic Rhinitis: management
intranasal steroid
oral/intranasal antihistamine
trigger avoidance
immunotherapy
44
Sinusitis: presentation
```
SX > 10-14D W/O IMPROVEMENT
purulent nasal discharge
sinus pain
+/- fever
halitosis
headache
dental pain
```
45
Sinusitis: MC pathogen
S pneumoniae or H flu
46
Sinusitis: diagnosis
clinical
if chronic:
- water's view xray
- culture
- CT
47
Sinusitis: treatment
```
abx (AUG or AMOX)
sx therapy (irrigation, analgesics, humidifier)
```
48
With recurrent/severe sinusitis, what other disorder needs to be considered?
cystic fibrosis
49
Pharyngitis:
- MC etiology
- presentation
viral
```
red throat
congestion
fever
fatigue
swollen cervical nodes
```
**adenovirus: B conjunctivitis
50
Pharyngitis: treatment
education
analgesics
fluids
rest
51
Pharyngitis: EBV:
- aka
- MC population
- incubation period
infectious mononucleosis
adolescents
4-8wks
52
Pharyngitis: EBV: presentation
```
EXUDATIVE TONSILLITIS
CERVICAL LYMPHADENOPATHY
fatigue
malaise
headache
fever
SPLENOMEGALY
```
53
Pharyngitis: EBV: diagnosis
fingerstick (monospot)
| EBV titer
54
Pharyngitis: EBV: treatment
spleen precautions (6-8wks)
monitor fluids/airway
analgesics
+/- steroids
**AMOX --> rash
55
Pharyngitis: GABHS: presentation (>3yo)
```
abrupt onset
fever
sore throat
HA
NAUSEA
abd pain
RASH
```
56
Pharyngitis: GABHS: presentation (<3yo)
nasal congestion
low fever
ant cervical lymphadenopathy
57
Pharyngitis: GABHS: physical exam
```
exudative tonsillitis
palatal petechiae
+/- scarlatiniform rash
halitosis
coated tongue
```
58
Pharyngitis: GABHS: diagnosis
```
rapid strep antigen test
throat culture (gold standard)
```
59
Pharyngitis: GABHS: treatment
abx (PCN VK)
analgesics
fluids
reduce transmission
60
Pharyngitis: GABHS: Acute Rheumatic Fever:
- course
- age group
2-3wks post strep infx
5-15yo
61
Pharyngitis: GABHS: Acute Rheumatic Fever: Jones' Criteria
(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
What is the #1 cause of acquired valve disease worldwide?
rheumatic heart disease
63
Pharyngitis: GABHS: Acute Rheumatic Fever: diagnosis
ASO titer
64
Pharyngitis: GABHS: Acute Rheumatic Fever: treatment
abx (AMOX)
anti inflammatories (ASA)
evaluate for carditis
65
Pharyngitis: Post Streptococcal Glomerulonephritis: what is it
inflammation of glomeruli secondary to deposition of immune complexes
66
Pharyngitis: Post Streptococcal Glomerulonephritis: presentation
```
edema
hematuria (TEA COLORED URINE)
proteinuria
HTN
Na and water retention
```
67
Pharyngitis: Post Streptococcal Glomerulonephritis: diagnosis
ASO titer
68
Pharyngitis: Post Streptococcal Glomerulonephritis: treatment
```
self limited (resolves wks-mos)
maybe diuretics
```
69
Peritonsillar abscess:
- pathogen
- age group
S pyogenes, polymicrobial
MC in older/adolescents
70
Peritonsillar abscess: presentation
```
difficulty/pain swallowing
DROOLING
dec oral intake
change in voice (HOT POTATO/MUFFLED)
respiratory distress
neck swelling/lymphadenopathy
TRISMUS
```
71
Peritonsillar abscess: diagnosis
clinical (deviated uvula, tonsilar edema)
CT w/ constrast
aspiration
72
Peritonsillar abscess: management
airway
drainage
high dose IV abx
73
Coxsackie Virus:
- aka
- epidemiology
hand food and mouth
<5yo
daycare outbreaks
74
Coxsackie Virus: presentation
oral lesions - herpangina (tongue, palate, tonsillar pillars)
maculopapular/vesicular rash (hands, feet)
```
low fever
refusal to eat/drink
drooling
sore throat
HA
```
75
Coxsackie Virus: treatment
supportive
| popsicles
76
Herpetic Gingivostomatitis:
- pathogen
- presentation
HSV 1
ulcerative lesions (gingiva, mucous membranes, perioral) -- bleed
3-4d prodrome
fever
sleeplessness
headache
77
Herpetic Gingivostomatitis: treatment
oral acyclovir
NSAIDs/APAP
hydration
78
Measles (Rubeola): prodrome
fever, malaise, anorexia
-->
CONJUNCTIVITIS, CORYZA, COUGH
KOPLIK SPOTS (48hrs before rash)
79
Measles (Rubeola): exanthem
maculopapular, blanching rash (FACE --> NECK, TRUNK, EXTREMITIES)
80
Measles (Rubeola):
- complication
- diagnosis
encephalitis
IgM assay
81
Measles (Rubeola): treatment
prevent spread
| supportive therapy
82
Mumps:
- incubation
- presentation
14-18d
2-3d prodrome
PAROTITIS (U-->B)
loss of angle of jaw bone
83
Mumps: complications
```
ORCHITIS (fever, testicular pain/swelling)
OOPHORITIS
encephalitis
sensorineural hearing loss
neurologic syndromes
```
84
Mumps: treatment
supportive
| prevent transmission
85
Rubella (German Measles):
| presentation
fever
postauricular + occipital adenopathy
acute onset maculopapular rash (face first)
86
Rubella (German Measles): consequences
```
congenital rubella syndrome:
hearing loss
mental retardation
CV defects
ocular defects
retarded growth
purpuric "blueberry muffin" rash
jaundice
thrombocytopenia
deafness
```
87
Rubella (German Measles):
| treatment
supportive
prevent transmission
vaccinate
88
Diaper Candidiasis: presentation
beefy red erythema w/ satellite lesions
| involves SKIN FOLDS
89
Diaper Candidiasis: treatment
```
topical antifungals (clotrimazole, nystatin)
barrier ointment
gentle cleansing
diaper free time
NO STEROIDS
```
90
Cradle Cap:
- aka
- presentation
- course
seborrheic dermatitis
greasy yellow scales on scalp (also ear, face, diaper area)
3wk-12mo
91
Cradle Cap: treatment
emollient
soft baby brush/toothbrush (removes gently)
sev, ref: topical steroid, ketoconazole shampoo
92
Impetigo:
- age group
- MC pathogen
2-5yo
S aureus
93
Impetigo: non bullous presentation
MC
papules --> vesicles --> thick HONEY COLORED CRUST w/ surrounding erythema (face, extremtities)
94
Impetigo: bullous presentation
flaccid bullae w/ clear yellow fluid
rupture --> brown crust
(trunk)
95
Impetigo: treatment
mild: mupirocin topical
sev: mupirocin ointment + PO abx (keflex)
