EENT Flashcards
(151 cards)
1
Q
Mild injection of the conjunctiva present several hours after birth
A
Chemical conjunctivitis
Irritation from the use of opthamalic preparation at birth
APPEARS IN FIRST 24 hours
decrease due to the discontinuation of six silver nitrate.
Last no longer than 3 to 4 days.
No tx
2
Q
Copious purulent discharge 2 to 5 days after birth from Eyes
A
Gonococcal conjunctivitis due to the transmission of necessariea gonorrhea
Highlighter green
3
Q
Mild mucopurulent discharge from eyes few days to 2nd weeks after birth typically day 7 to 14
A
Chlamydia conjunctivitis
4
Q
Gonorrhea diagnostic test conjunctivitis
A
Gram stain of conjunctiva scrapings and Prulent discharge or Gram stain shoes gram negative intercellular diplococci verified by culture either the chocolate agar or thyar Martin medium
5
Q
Gonococcal conjunctivitis management
A
Ocular emergency can cause blindness hospitalization is necessary
Irrigation with normal Saline
Systematic antibiotics IV or IM
IV Pen G
Or
Ceftriaxone / cefotaxime x7 days
do you not give Rocephin in newborns with hyperbili
6
Q
Pneumonia is also associated with this can have increased WOB and mild to moderate injection and Chemosis of conjunctiva
A
Chlamydia trachomatis conjunctivitis
7
Q
Chlamydia conjunctivitis test
A
Giemsa Stain of conjunctival scrapings may reveal intracytoplasmic inclusion bodies
Immunofluorescent in a body staining of conjunctival scrapings highly sensitive and specific
CXR if PNA
8
Q
Chlamydia tracomatis conjunctivitis management
A
Erythromycin eye ointment x2-3 week
Oral erythromycin can treat the conjunctivitis and may prevent subsequent pneumonia
Oral sulfonamides (trimethoprim , sulfamethoxazole) if intolerant to erythromycin
9
Q
Bright red and irritated conjunctiva can also have satellite lesions
A
HSV conjunctivitis
10
Q
HSV diagnostics
A
Fluorescein exam looking for satellite lesions, obtain HSVPCR and culture
11
Q
First line treatment for her herpes simplex virus conjunctivitis (HSV)
A
Acyclovir
Warm compress to remove excudate
Hand washing
Hospitalized if conjunctivitis or satellite lesions
Immediate referral to ophthalmologist
12
Q
Pathogens of bacterial conjunctivitis
A
Staphylococcus aureus, H.influenzae, streptococcus pneumonia, and Moraxella catarrhalis
13
Q
Occurs in about 25% of young children less than three years and most often associated with H.influenzae in the ipsilateral (same) eye/ear
A
Conjunctivitis Otitis syndrome
14
Q
Primarily due to adenovirus viruses 3,4 and seven
A
Viral conjunctivitis
Can result from HSV, varicella, herpes zoster
15
Q
Commonly associated with seasonal allergies Both eyes feel itchy and watery
A
Allergic and vernal (chronic) Conjunctivitis
16
Q
Cobblestone appearance of bilateral conjunctiva
A
Allergic conjunctivitis
Affects both eyes accompanied by nasal congestion, sneezing, I would swelling and sensitivity to light
not contagious
17
Q
Allergic conjunctivitis management
A
Decongestants, topical Antihistamines, oral
18
Q
Viral conjunctivitis has what type of discharge
A
Watery or thick stringy mucoid
19
Q
Watery discharge lasting 10 to 14 days scratchy sensation and some URI symptoms affecting one or both eyes
A
Viral conjunctivitis
Highly contagious AKA PINK EYE
20
Q
Bacterial conjunctivitis has what type of discharge
A
Perulent , glued eyes after sleeping
Can I have crusting upon awakening green yellow color
Begins unilateral
21
Q
Viral conjunctivitis treatment
A
Symptomatic care
Mild: saline/artificial tears refrigerated is best
Moderate: decongestant/anti-histamines, NSAIDs
22
Q
Bacterial conjunctivitis management
A
Erythromycin 0.5% opthamalic ointment
Polytrim (polymyxin B sulfate trimethoprim) Tobramyosin, Vigamox
23
Q
Use the cover and cover test to see the reflection of light in both eyes
A
Corneal light reflex
24
Q
I bought is too long causing the visual image to fall in front of the retina
A
Myopia
My=me I have this can’t see far away
Occurs during school age can’t see the board
25
Nearsightedness
Myopia
26
Pupils should see a crisp Red/orange and round retina
Red light reflex
| 2.5 years till melynization
27
Farsightedness
Hyperopia
28
Eyeball is too short Visual images focus behind the retina ability to see objects clearly at a distance but not in close range
Hyperopia
Mom
Complaints of inability to read
Can I have a headache, ice cream, squinting, Eye rubbing
29
Hyperopia can resolve by what year
Resolves by 6 years
30
Passing vision screen for a three-year-old
20/50
31
Passing vision screen for a four-year-old & 5 year old
20/40
| 20/30
32
Amaurosis
Blindness
| And ability to distinguish light from darkness to partial vision
33
Legal blindness
Distant visual acuity of less than 20/200 corrected
34
Low vision
Visual cue between 20/70 and 20/200 corrected
35
Primary blindness
Present at birth
36
First symptom of blindness
Can I have nystagmus
Enlarged or clouded cornea
Abnormal or absent red light reflex
Fixed or intermittent strabismus be on six months
Developmental delays, increased anxiety around strangers, increase self stimulating behavior hand flapping rocking
Wondering eye
Chronic tearing
37
Diagnostic test of blindness
Ophthalmologist exam showing abnormal vision
Developmental testing
CT or MRI to rule out pathologic abnormalities
38
Causes of amblyopia
Trauma, organic lesion, cataract
Sensory stimulation deprivation or disuse during infancy and early childhood
Rarely bilateral
Can occur with strabismus
39
Diagnosis and management of amblyopia
Specific ophthalmology findings rule out underlying causes like cataracts diseases of that eye
Early detection, part referral to ophthalmologist
Corrective lenses
Patch use focusing on stimulation of the amblyopic eye
40
Involuntary rhythmic or jerky movements of the eyes
Nystagmus
Normal until one month of age , acute acquired nystagmus is concerning
Associated with albinism, refractive errors, central nervous system abnormalities , may be familial
41
Treatment for nystagmus
Referred to ophthalmologist three underline problem as possible
42
Crossed eye
Muscles of iron not coordinated
Strabismus
43
Esotropia
Eye turned inwardly
44
Exotropia
Eye turned outward
45
Hypertropia
Eye turned upward
Hyper =UP
46
Hypertropia
Eye turned downward
Hypo=down
47
What is the evaluation test for strabismus
Cover and uncover test
EOM testing
Vision acuity
Pupil test hirschburg Looking for lateral motion of the covered Eye
48
Hirschburg test
Pupillary light reflex looking for the lateral motion of the eye Will be unequal if strabismus is present
49
Treatment for strabismus
Treat once ocular misalignment > 6 months of age or if Constant or fixed strabismus at any age or hyper/hypertropia immediately, and urgent referral if any underlying CNS abnormality is suspected
Treatment may include:
surgery between six months and two years of age
patching or covering of the unaffected known as occlusion therapy
Correct of lenses
Orthotic exercises
Medication atropine sulfate (dilates unaffected eye forces you said the deviating Eye)
50
Lazy eye or decrease visual acuity and one or both eyes caused by an inadequate or an unequal visual stimulation
Amblyopia
Dad has this!!!
Occurs in visually immature children lack of clear image on the retina due to immature visual system
51
When does a child reach visual maturity
7-9 years
52
Automated vision screening including photo screening an auto refraction is preferred for children at what age to test vision
6 months to 3years
53
Visual acuity charts are the reliable method of screening for vision and children’s at what age
Ages 4 to 5 years
54
If unable to test visual acuity how long should the provider wait to reattempt
4 to 6 months
55
If four years of age and unable to test visual acuity when should the provider attempt again
One month
56
Each eye with a different refractive error variation axle or curvature of the cornea light focus front or behind cornea
Anisometropia
57
Results on there is an uneven curvature of the cornea causing blurred vision at near and far distances
Astigmatism
58
Opacity of the lens
Cataract
59
Sign and symptoms of Cataracts
```
Gauze over the lens
Poor visual acuity
Dim vision
PAINLESS
photophobia
May be associated with hypoglycemia, hypo parathyroidism, galactosemia, microphathlmos
```
Black dots surrounded by red reflex, white plaque opacities, leukocoria
60
Causes of Cataract in children
A. Trauma to the eye, possibly due to child abuse
B. Systematic disease like DM, trisomy 21, hypo parathyroidism, a topic dermatitis, Marfan syndrome
C. Complication of other ocular abnormalities E.G. glaucoma, strabismus
D. 30% hereditary
61
Leukocoria
Absent red reflex
| Seen in Cataracts
62
Cataract treatment
Prompt referral to ophthalmologist, surgery indicated for visual correction
63
Increased intraocular pressure from disruption of aqueous fluid involving one or both eyes in can result in optic nerve damage
Glaucoma
64
Glaucoma that occurs within the first three years of life; 40% present at birth; 85% by one year of age
Congenital glaucoma
65
Glaucoma that begins between three and 30 years
Juvenile glaucoma
66
Causes of glaucoma
Secondary causes include trauma, intraocular hemorrhage, tumor, cataracts, corticosteroid use
67
classic triad photophobia, abnormal overflow of tears (Epiphora), Eyelid spasm (blepharospasm)
May also have decreased vision and persistent ACUTE extreme pain of eye
Signs and symptoms of glaucoma
Deep cupping of optic disc, corneal haziness in Edema, conjunctival injection, corneal enlargement > 12 mm
68
What is the management of glaucoma
Glaucoma pressure test will show increased pressure
| Immediate prompt referral to ophthalmologist to confirm diagnosis and initiate therapy surgery is often the first line
69
Granulomatous inflammation of the Meiobian glands occurring on the conjunctiva aspect the inner lining of the eyelid, nontender cyst
Chalazion
70
Signs and symptoms of a Chalazion
```
Slow growing
painless, mass on eyelid
most often upper eyelid
Minimal redness/slight edema
Firm nontender localized nodule often midline
```
71
Mangement chalazion
Small ones may resolve without treatment
| Apply warm compresses 2 to 3 times a day for 20 minutes
72
Integrity of the eye is disruptive loss of vitreous humor
Ruptured globe
73
Signs and symptoms of a ruptured globe
Pain, photophobia, injection, hyphema
Distortion of eye “pupil leaking”
74
Management of ruptured globe
Emergent referral to ophthalmology
75
Loss of epithelial lining from corneal surface of one or both eyes
Corneal abrasion
76
Sensation of a foreign body, pain, photophobia, tearing, decreased vision, may have mild sclera erythema
Corneal abrasion symptoms
77
What antibiotic is used for corneal abrasion ?
Polytrim (Bactrim) Antibiotic drops also symptomatic care
78
How do you diagnose and evaluate a corneal abrasion?
Fluorescein staining cobalt blue light (woods lamp)
Dye shows scratches
79
Blood in anterior chamber of eye
Hyphema
Opthamalic emergency , reduced activity
80
Unilateral or bilateral obstruction nasal lacrimal duct
Dacryostenosis
| Blocked tear ducts
81
Dacryostenosis
Spontaneous resolution by 12 months
| Constant wet / tearing eye no redness
82
Dacrocystitis
Dacro =lacro
Infection of obstructed duct
83
Fever, erythema, edema, tenderness pver NLD
Dacrocysitis
84
Dacrocystitis treatment
ED IMMEDIATELY
| ABx drops
85
Cats eye / Leukocoria
Retinoblastoma
| Whiteness in picture
86
Retinoblastoma
Cats eye
Hereditary-bilateral
Non hereditary- unilateral
Cancer
Refer to opthomologist
87
Vascular pathologic disease of retina
Retinopathy of prematurity
Increased vascularization of the eye refer to pediatric opthamology
Laser therapy
88
An acute / Sudden localized inflammation of the sebaceous glands of the eyelids
Hordeolum ( stye)
| Red tender papule
89
Most common infectious pathogen for a stye?
S. Aureus
| P. Argunosia
90
Stye treatment
Spontaneous rupture common
Warm compresses
Sulfacetamide 10%
Polymyxin B -bacitracin
Or erythromycin
91
Inflammation infection of the soft tissues of the orbit posterior of the orbital septum can involve the ocular muscles and optic nerve
Orbital cellulitis
92
Inflammation infection of the skin and subcutaneous tissue surrounding the eye
Unilateral eyelid edema
Periorbital cellulitis
Warmth redness fever may occur
Vision normal
93
Acute infection of the external auditory canal
| Swimmers ear
External Otitis media EOM
94
Management of EOM
Otis drops
| Ofloxacin , ciprodex, neomycin, polymyxin,fluoroquinolone
95
Sensorineural hearing loss
Resulting damage to the cochlear structure of the inner ear were auditory nerve
Can be caused by torches, prematurity, medication exposure, or inherited
96
Conductive hearing loss
Normal bone conduction and reduced air condition due to the obstruction Results from blocked transmission soundwave from external auditory canal to inner ear
this is more common
97
Causes include OME, wax, foreign body
Causes of conductive hearing loss
98
Hearing screening
Screen at birth
Repeat screen by 1 month
DX @3 months
Treated at six months or sooner
99
Symptomatic infection of the middle ear
Acute otitis media AOM
6-36 months most common
100
Causes of AOM
Viral
S.pneumoniae
M.catarrhalis
H.Flu (PCN resistance)
101
What is the gold standard for diagnosing AOM
Pneumatic Otoscopy
Tympanometry confirms
102
Red TM, distorted landmarks, rupture with drainage
AOM
103
Treatment for AOM
Amoxicillin 80-90 mg/kg/day BiD divided
2nd line augmentin
<2 x10 days
>6 5-7 days
104
No improvement of AOM in 72 hours of amoxicillin treatment
Assume beta lactamase
Augmentin , Cefdinir
105
OME
Otitis media with effusion
AKA serous otitis media
Fluid in middle ear space (thickened mucus production)
Decreased mobility with no signs of AOM
Bubbles
Yellow/dull color or translucent TM, appears retracted to the negative pressure and middle ear, no vascularity
This case is resolved on own without anabiotic‘s, refer if longer than three months or associated hearing loss
106
What’s causes OME
Caused by viral illness/allergies , hypertrophic adenoids
Eustachian tube dysfunction
Sequel to AOM 25% to 35% of all cases
107
Most common cause of conductive hearing loss
OME
108
Tympanostomy tubes
Surgical incision of the eardrum and placement of ventilation tube to relieve pressure and drain pus/fluid from middle ear
109
Mastoiditis
Infection of mastoid cells
Redness behind ear (post auricular swelling)
Concurrent/recurrent AOM occurs secondary to this
fever , otalgia
110
Mastoiditis management
CT bony involvement
CBC elevated WBC‘s
Culture to rule out sepsis
Refer ent, po / I’ve abx and mastiodectomy
111
FB in ear mangement
Remove
Refer ent
Otic abx drops
112
FB nose
Remove object
Angel kids parents mouth to mouth
Ent if unable to get out
Initial symptoms of sneezing, mild discomfort can lead to infection
113
Pressure at kiesselbachs triangle
Management of epitaxis
114
Epitaxsis
Common and dry climates
Usually benign or mechanical nasal picking
Chronic use of nasal decongestion AFRIN
Apply ice
CBC, platelets, PT, PTT if bleeding disorder suspected
115
Rhinitis
| “AR”
URI
Caused by a variety of viruses most common rhinovirus a.k.a. the common cold
7 to 10 days; Day 1 to 3 ramping up; day 5 to 7 worst; day 10 to 14 resolution signs and symptoms
Acute onset of symptoms low-grade fever, pharyngitis, rhinorrhea, conjunctivitis, cough (nonproductive) worsens at night due to postnasal drip, allergic shiners and salute with nasal crease, nasal mucosa pill, boggy and Edematous , sinus h/a
116
Rhinitis management
Symptomatic, no cold medications under the age of 6, hydration, nasal bulb suctioning, rest
Anti- histamine, Benedryl, nasal spray (beclomethasone /fluticasone) , normal saline
117
Sinusitis
Common in school agers
Do not diagnose b4 9 years
S/s: sinus pressure, purlent drainage
118
The diagnosis of acute bacterial sinusitis is made when______.
Diagnosis of acute bacterial sinusitis is made when a child with an acute upper respiratory tract infection presents with:
1. persistent illness nasal discharge or daytime cough or both lasting more than 10 days without improvement
2. A worsening course Or new onset of nasal discharge, daytime cough, or fever after initial improvement
3. Severe onset concurrent fever and nasal discharge for at least three consecutive days
119
Sinusitis management
```
Amoxicillin clavulanate (augmentin)x10 days
Levaquin if no improvement
```
Decongestants/Anna histamines are not useful
Pain management
humidification
Nasal spray budesonide is a topical inhaled steroid
Use with caution for no more than three days
Swimming in moderation
120
Centor criteria
Pharyngitis/tonsillitis clinical features most suggestive of group a beta-hemolytic streptococci (GABHS) =FLEA
1. fever
2. lack of cough
3. pharyngal tonsillar excudate
4. anterior cervical adenopathy
2 or more do a strep test!!!!
121
Group a beta-hemolytic Streptococcus GABHS
Strep pharyngitis
Abrupt onset of sore throat, no nasal symptoms, or cough, fetid breath, fever common , headache, nausea, belly pain, vomiting
122
Why do we treat strep pharyngitis
Treating to prevent rheumatic fever
123
Scarletintinform rash
Scarlet fever secondary to strep pharyngitis
124
Treatment of choice for strep pharyngitis
Penicillin or amoxicillin 50 mg /kg/day PO q day or divided twice a day
Change tooth brush after 48 hours
Pain meds
Hydrate I
125
Treatment for strep pharyngitis in penicillin allergic
Keflex cephalexin 25 to 50 mg/kilogram/day divided b.i.d.
| Azithromycin 12 mg/kilogram/day x5 day
126
Caused by the Epstein bar virus EBV
Mononucleosis
127
Signs and symptoms Low grade fever, cervical lymph nodes swelling, sore throat, fatigue, anorexia, slow onset, possible excudate
Mononucleosis
Can I also have splenomegaly, and maculopapular for Petechial rash
128
Classic triad of MONO
Fever, pharyngitis, lymphadenopathy
129
IGM versus IgG in EBV
Mother’s before grandmother
Early rise IgM (positive) permanent rise IgG
+IGM = early primary infection
+ IGG = past infection
+IGM & IGG = acute primary infection
-IGM &IGG= negative EBV status
130
How long should a person with infectious mononucleosis avoid sports or activity
3 weeks due to the risk of splenomegaly and splenic rupture
131
What drugs do not treat infectious mononucleosis with?
Amoxicillin it will give a rash
132
Left upper quadrant pain in infectious mononucleosis
Complication of mono =ruptured spleen
133
A 15-year-old male presents with complaints of general malaise and fatigue for the past few weeks without resolution. He has also had a fever and sore throat. All the final exam findings with support the diagnosis of infectious mononucleosis except:
White excudate on tonsils
Hepatomegaly
Maculopapular rash
Diffuse cervical lymphadenopathy
Hepatomegaly
Mono has splenomegaly not hepatomegaly all the other are findings of mononucleosis
134
Sore throat with bulging posterior soft palate and deviation of you allowed to opposite side that’s unilateral
Peritonsillar abscess
Airway emergency!!!
135
What causes a peritonsillar abscess?
Complication of pharyngitis due to the accumulation of purulence in a tonsillar fossa causing a cellulitis that leads to abscess
136
Treatment of peritonsillar abscess
Needle aspiration, IV anabiotic‘s penicillin, nafcillin,oxacillin
Hydration
137
Lateral neck radiography or CT shows a widen retropharyngeal space
Diagnostic study indicative of retropharyngeal abscess
138
Retropharyngeal abscess
Inflammation of the posterior aspect of the pharynx and retropharyngeal lymph nodes causing sore throat with bulging pharynx can be an airway emergency
Fever , pain swallowing and refusal
Turn head
Emergency referral to ENT
139
Seal like cough
Croup
140
What causes croup
Para influenza virus of the Larynx
141
Steeple sign
Diagnostic x-ray finding indicative of croup
| Not necessary dx test
142
What is the management of croup?
Symptom Medicare, single dose Decadron 0.8 mg/kilogram PO x once
143
Following a URI in a 3 to 10 year old, unable to swallow sitting in a tripod position and breathing really fast
Epiglottitis
Bacterial infection
144
Thumbs sign
X-ray finding indicative of epiglottitis steeple sign would show croup
145
High fever , drooling, sore throat, unable to swallow
Epiglottitis
146
Oral Candidiasis
Thrush common used infection of the oral Mucosa
White patches in mouth can be painful or not
Treat with Mr. and oral suspension four times a day times 10 days
Treat breast feeding mother (cross infection)
Sterilize pacifiers /nipples
147
What pathogens cause epiglottis
Beta-hemolytic streptococci, pneumococci, H influenzae
Decreasing of influenzae with the use of HiB vaccine
148
What finding may accompany macrocephaly?
1. pulsating anterior fontanelle
2. Sunken Fontanel
3. premature closure suture lines
4. Widened suture lines
Widen suture lines
Pulsating anterior fontanelle can be a normal variant or due to increased ICP. Sunken fontanelle can accompany dehydration and premature closure of suture lines = small head
149
Which of the following conditions increases the risk of developing hydrocephalus?
Bilateral cephalohematoma‘s
Craniostenosis
Prematurity
familial microcephaly
Prematurity
Bilateral cephalohematoma as a result of underline skull fracture
Craniostenosis (premature closure of the sutures) can result in increase cranial pressure if severe and family macrocephaly is normal and not associated with pathology
150
Confirming the diagnosis of chlamydia Conjunctivitis in the newborn would best be done by obtaining which of the following?
Cervical swab of the mother
You’re in PCR from the mother
Culture from the eye discharge
Culture of the conjunctival scrapings
Culture of conjunctival scrapping
Chlamydia is a intracellular organism and needs epithelial cells test sample
Testing the mother would not directly tell us what is causing the newborn symptoms
151
Automated vision screenings including photo screening and auto reflection is preferred for children aged ____ to _____. Visual acuity charts continue to be a reliable method of screening for children aged _____ to ____ years.
6 months to 3 years
