Skin & HEENT

Question 1

Cataracts

1. Galactosemia
   - - what is the enzyme deficiency?
   - - predisposition to what kind of sepsis?
2. Inherited cataracts are usually what MoI?
3. What torch infection is most closely associated?

Answer 1

Cataracts

1. Galactosemia
   - -Gal-1-P-uridylyltransferase deficiency
   - -predisposed to E. coli sepsis
2. AD
3. Rubella

Question 2

Ectopia lentis - displacement of the lens

Associations

1. trauma (most common)
2. What connective tissue diseases? (2)
3. What metabolic disease?

Answer 2

Ectopia Lentis

1. trauma
2. Marfan Syndrome
3. Ehlers-Danlos
4. Homocystinuria

Question 3

Opthalmia Neonatorum (neonatal conjunctivitis)

Etiologies

1. in first day of life?
2. in first week of life?
3. in second week of life?

Answer 3

Opthalmia Neonatorum

1st day: Chemical
–silver nitrate, erythromycin

1st week: N. gonorrhea
–tx: ceftriaxone

2nd week: C. trochomatis
–tx: erythromycin

Question 4

persistent URI s/s for at least 10 days

Dx and Tx?

Answer 4

Bacterial Sinusitis

Etiologies

• -S. pneumo
• -nt H. flu
• -M. catarrhalis
• -S. aureus (chronic)

RF: viral URI

Pathophys: viral URI –> sinus inflammation and edema –> impaired clearance of bacteria

Tx: Amoxicillin-clavulanate

Question 5

Periorbital (Preseptal) versus Orbital Cellulitis

Common s/s

• -eyelid edema, erythema, tenderness
• -fever, leukocytosis

Which one is mild and can be treated with oral abx?

Which one is serious and can be identified by presence of opthalmoplegia, pain w EOM, proptosis, or vision impairment?

Answer 5

Periorbital (Preseptal) Cellulitis

• -mild
• -tx: oral abx

Orbital Cellulitis

• -opthalmoplegia, pain w EOM, proptosis, vision impairment
• -complications: blindness, subperiosteal abscess, cavernous sinus thrombosis, intracranial infxn
• -tx: hospital IV abx

Question 6

1. Newborn that is cyanotic; becomes pink with crying. Dx?

2. Most common cause of nasal polyps in children less than 12y?

Answer 6

1. Choanal atresia
2. CF –> nasal polyps

NB: epistaxis tx
–local oxymetazolone or phenylephrine

Question 7

1. follicular conjunctivitus; pannus (neovascularization) formation in the cornea
2. pain, photophobia, decreased vision; dendritic ulcer
3. copius purulent eye discharge 2-3d after birth; swollen eyelids and chemosis
4. injected conjunctiva with copious watery discharge; often associated with swimming pool exposure
5. abrupt onset of fever, proptosis, restricted EOM; swollen, red eyelids; concomitant paranasal sinus infxn
6. fever; eyelid erythema and tenderness
7. chemosis, eyelid swelling, watery mucoid discharge 5-14d after birth

Answer 7

1. Trachoma
2. Herpes simplex keratitis
3. Gonococcal conjunctivitis
4. Viral conjunctivitis
   - -adenovirus
5. Orbital cellulitis
6. Preseptal (periorbital) cellulitis
7. Chlamydial conjunctivitis