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Flashcards in EENT Deck (82):
1

If a patient presents with epistaxis, mouth breathing, or unilateral stinky nose drainage, think?

foreign body

2

congenital glaucoma management?

emergent referral to optho

3

Which type of hearing loss is most common in children?

conductive

4

4 main causes of sensorineural hearing loss in children

- TORCHES (Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), Herpes infections)
- prematurity
- medication exposure
- inherited

5

glaucoma would be considered secondary or juvenile if it showed up at what age?

3-30 years

6

Management for Dacrostenosis should include warm compresses followed by ___, how many times a day? What is the treatment?

warm compresses then firm massage ten times in a row, 4x/day

no "treatment," unless there's conjunctivitis - then you'd treat with topical ophthalmic ointment

7

If a patient presents with preauricular node swelling, mild chemosis, purulent crusting of eye upon awakening, may have URI associated sx -- think?

bacterial conjunctivitis

8

Retinal vascular pathologic disease due to early gestation and LBW

ROP, followed by optho

9

If conjunctivitis occurred 2-5 days after birth, with marked chemises and eyelid edema, marked mucopurluent eye discharge, what would this be?

Gonococcal ophthalmia neonatorum

10

If a child presents with unilateral eyelid edema, erythema surrounding the eye extending downwards, induration and tenderness, fever, think?

periorbital cellulitis

11

Children under age <3 do not have the same receptors in their throat that cause thematic heart disease so if suspected GABHS do not do ___ or ___

RST or TC

12

If a patient presents with mild eye injection, stringy white discharge, edema of lids, chemosis, and cobblestone appearance of conjunctivae (itchy, watery eyes), think?

Allergic conjunctivitis

13

Lab analysis of neonatal ocular discharge would be positive for gram negative intracellular diplococci for which of the following organisms?
1. chlamydia
2. influenza
3. adenovirus
4. gonococcus

4. gonococcus

14

Chlamydia trachomatis labs, treatment?

labs: culture conjunctiva

TX: erythromycin eye ointment for 2-3 weeks

hospitalize/CXR if respiratory sx

15

management of Gonococcal ophthalmia neonatorum: labs, treatment? Which antibiotic?

labs: culture conjunctiva

TX: hospitalize with IV antibiotics (ceftriaxone, cefotaxime) for 7 days

16

What is the most common cause of conductive hearing loss in children?

otitis media with effusion

17

Counsel families that viral conjunctivitis may last up to ___ days

10-14

18

Involuntary rhythmic or jerky movements of the eye(s)

nystagmus

19

3 main causes of conductive hearing loss in children

- OME
- wax
- foreign body

20

Peak incidence of AOM is between __ and __ months of age

6-36 months

21

Which of these is the correct tx for strep throat?

1. Penicillin V 250mg BID for 5 days and tylenol for pain/fever
2. azithromycin for 5 days and ibuprofen
3. penicillin V 500mg BID for 10 days with tylenol for pain or fever
4. cephalexin 500mg BID for 5 days

3. penicillin V 500mg BID for 10 days with tylenol for pain or fever

22

Most viral conjunctivitis is caused by

adenovirus

23

When a child presents with intermittent or continuous tearing, accumulation of mucus or crust on the lashes and lower lid especially on awakening, and the PE shoes tearing or mucoid drainage with palpation of the nasolacrimal sac, what is this?

Dacrostenosis

24

At age 5, what vision level is normal?

20/40

25

If a child presented with chronic OM with malodorous purulent drainage, vertigo, hearing loss?

Cholesteatoma - refer for surgical excision

26

SNAP prescription for AOM is indicated if

over 2 years of age, not ill, or dx not clear

27

Disturbance in the circulation of aqueous fluid in the eye increasing the pressure and resulting in damage to the optic nerve

Glaucoma

28

If AOM doesn't response to treatment within 72 hours, you would assume what and prescribe what?

assume beta lactase

prescribe augmenting or cefdinir

29

epiglottitis management

leave the child in a position of comfort until you have control of the airway

broad spectrum antibiotics ( β-lactamase–resistant antibiotic, such as ceftriaxone) IV

30

Most common cause of AOM is ___

viral

31

What should you suspect if there are HSV lesions on the top half of the face

Herpes Simples Keratoconjunctivitis

32

Diagnosis of Herpes Simples Keratoconjunctivitis?

obtain HSV PCR and culture (unroof a vescile and twirl swab in center)

fluorescein eye exam to look for stellate lesions

33

What is the most common cause of croup in the fall?

Parainfluenza

34

Treatment for AOM

amoxicillin 80-90mg/kg/day divided BID

under 2 years? 10 day course
over 6 years with mild/moderate disease? 5-7 days

35

Spontaneous resolution of Dacrostenosis usually occurs by ___ months

8-12

if not, refer to optho

36

Croup is most common in what age group?

6-36 months

37

If patient present with typically bilateral, swelling and erythema with flaky scaly debris on eyelid margins and gritty burning feeling in eyes, this would be

blepharitis

38

nystagmus is normal until what age?

1 month

39

Which of the following set of symptoms would be most consistent with GABHS infection?

1. cough, nasal congestion, cervical lymphadenopathy
2. fever, HA, tender cervical lymphadenopathy
3. cough, fever, macular papular rash to trunk
4. sneezing, rhinorrhea, exudative tonsils

2. fever, HA, tender cervical lymphadenopathy

40

bacterial conjunctivitis treatment?

poly trim, tobramycin, vigamox drops

41

if unable to check eyes at age 3, when should you re-atempt?

4-6 months later

42

If patient present with severe throat pain such that they cannot swallow, are tripoding, and tachypnea, and usually these symptoms have followed a URI, this would be

bacterial tracheitis/epiglottitis

43

Treatment of GABHS

penicillin 20-50mg/kg/day divided 2x/day (max of 1000mg)
OR
CR OR LA penicillin once

Administer a minimum of 20 mg/kg/day; larger children generally should receive 500 mg divided into 2 daily doses for 10 days.

44

Infection of an obstructed nasolacrimal duct with a history of fever, erythema, edema, and tenderness over the NLD with discharge?

Dacrocystitis

45

Treatment for otitis externa

otic drops (florin, ciprodex), wick

46

Uneven curvature of the cornea or lens causing blurry vision at near and far distances

Astigmatism

47

Opacity of the lens, may have strabismus, amblyopia, and photophobia - what is this and how do you manage?

cataract, refer to ophthalmology

48

Hordeolum (stye) is most commonly caused by which 2 pathogens?

s. aureus or p.aeruginosa

49

By what age is eye myelinization complete?

2.5 yrs

50

Strabismus affects __ percent of children. Of this percentage, __% present by age one, __% by age 4

5%

50% by age 1
80% by age 4

51

Up to age 7 vision may be ___ normally

20/30

52

When would you culture and/or refer for bacterial conjunctivitis?

if chronic

53

If patient present with URI symptoms, fever, barky cough, intermittent stridor, worse at night and early morning, this would be

croup

54

A child presents with swelling around the right eye for 24 hours. When evaluating to determine if they have periorbital cellulitis or orbital cellulitis which of the following findings would support the dx of orbital cellulitis?

1. hx and evidence of recent insect bite near the right eye
2. proptosis of the right eye and decreased EOM
3. induration, edema, and tenderness around the R eye
4. hx of being hit with baseball in right eye in past 48 hrs

2. proptosis of the right eye and decreased EOM

55

If child with periorbital cellulitis appears non-toxic, how do you manage/treat?

treat with single-dose ceftriaxone with close follow up

56

Most cases of congenital glaucoma show up by ___ months of age

12

57

are the majority of glaucoma cases bilateral or unilateral;?

bilateral

58

If patient presents with abrupt onset of sore throat, no nasal symptoms, hoarseness or cough, fetid breath, headache, nausea, belly pain, vomiting
(perhaps scalintiniform rash) think

Group A beta hemolytic strep (GABHS) pharyngitis

59

Decreased visual acuity caused by inadequate or unequal visual stimulation that is later not correctable with corrective lenses

Amblyopia

occurs in 2-4% of the population

60

treat all infants with AOM regardless of age if what signs/symptoms?

severe illness - Temp greater than 39 (102.2 F), severe pain

61

If symptoms include severe ear pain, ear fullness, discharge, or hearing loss, and on PE there is tragal tenderness and pain with exam, think?

otitis externa

62

Management of Dacrocystitis

ED immediately, admit for IV antibiotics

63

What is the main cause of epistaxis?

mechanical - nose picking

64

Croup has an incubation period of how many days?

3

65

When each eye has a different refractory error

Anisometropia

66

Belpharitis management includes

- scrub eyelids/lashes with no tear shampoo
- warm compresses to eyes
- antibiotic ointment

67

Treatment for rhinosinusitis

HD amoxicillin, bactrim, azithro or clatithromycin

Failure: HD augmentin

68

Most common form of conjunctivitis, presents during the second week after birth with mild to moderate injection and chemosis?

Chlamydia trachomatis

69

If child with periorbital cellulitis appears toxic, how do you manage/treat?

admit to hospital
CT
IV antibiotics

70

What is the gold standard for diagnosing AOM

pneumatic otoscopy

71

If a patient presents with a URI that's not getting better after 10 days or getting worse instead of better, and they have headache, fever, fatigue, dental pain, a cough that's worse at night -- PE reveals purulent rhinorrea, facial pain, hyposmia, malodors breath, think?

rhinosinusitis (there's acute chronic and allergic)

72

Visual maturity is reached by what age?

7-9 yrs

73

Croup tx

treat symptoms (fluid, pain meds) and decadron single dose

74

Treatment for allergic conjunctivitis?

Topical decongestants, mast cell stabilizers, topical antihistamines (zaditor), oral antihistamines

75

If patient presents with watery discharge in one eye and then the other, scratchy sensation, photophobia, URI sx, erythema of conjunctiva, what would you think?

viral conjunctivitis

76

The red reflex test is done in the newborn period to rule out:

1. retinoblastoma
2. decreased visual acuity
3. strabismus
4. corneal abrasion

1. retinoblastoma

77

When should you start checking visual acuity?

age 3

78

How would you diagnose strabismus?

corneal light reflex (not in the same place), cover/uncover test, EOMs would be normal, visual acuity testing would indicate amblyopia in the affected eye

79

Treatment for Herpes Simples Keratoconjunctivitis

PO or IV acyclovir
eye ointment
pain meds

80

age of peak incidence of epiglottitis?

3-10 years old

81

What is myopia? when does it normally develop?

nearsightedness

age 8-10

82

What is hyperopia? When is it normal, when should it resolve?

farsightedness

mild hyperopia normal in young children, should resolve by age 6