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EOR 3 - Peds > ENT/Pulm > Flashcards

ENT/Pulm Flashcards

1
Q

What used to be a common cause of neonatal conjunctivitis?

A

silver nitrate (now erythromycin used instead)

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2
Q

How can you tell difference b/w gonorrhea vs chlamydia conjunctivitis?

A 
G: onset: 2-5d of age 
copious purulent discharge 
C: onset: 4-19d of age 
hyperemia 
scant purulent discharge
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3
Q

What is the tx for gonorrhea conjunctivitis?

A

ceftriaxone

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4
Q

What is the tx for chlamydia conjunctivitis?

A

erythromycin (+ tx for gonorrhea (ceftriaxone))

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5
Q

What are the complications of gonorrhea conjunctivitis?

A

corneal perforation and scar threaten vision

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6
Q

What are the complications of chlamydia conjunctivitis?

A

pneumonitis

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7
Q

What is the most common cause of viral conjunctivitis?

A

adenovirus
swimming pools are the MC source

viral is MC in children

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8
Q

What is the MC cause of bacterial conjunctivitis?

A

S. pneumo, S. aureus

M. Catarrhalis

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9
Q

How does viral conjunctivitis present?

A

bilateral infection with watery drainage
may have viral prodrome
morning crusting is common (but less pronounced than bacterial)

self limited infection (10-21days)

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10
Q

How does bacterial conjunctivitis present?

A

unilateral, 2nd eye will follow in 24-48hours

purulent discharge and significant eye crusting

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11
Q

What is the tx for viral conjunctivitis?

A

artificial tears, topical antihistamines

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12
Q

What is the tx for allergic conjunctivitis?

A

topical antihistamines: olopatadine, pheniramine/naphazoline
Topical NSAIDs - ketorolac
Topical corticosteroids

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13
Q

What is the tx for bacterial conjunctivitis?

A

TMP/polymixinB drops during the day, erythromycin ointment at night

if contact lens wearer, cover for pseudomonas with floroquinolone or aminoglcoside

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14
Q

Orbital Cellulitis

A

extension of infectious sinusitis, dental, and trauma
MC association with ethmoid sinus infections

involvement of tissues posterior to the orbital septum

MC in children 7-12yo

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15
Q

How does orbital cellulitis present?

A

proptosis, edema, erythema
ophthalmoplegia (pain with eye movement)
HA, fever, malaise
Decreased vision

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16
Q

How is orbital cellulitis dx?

A

CT scan

MRI

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17
Q

What is the treatment for orbital cellulitis?

A

Hospital admission and IV ABX (clindamycin, vancomycin)

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18
Q

What is strabismus?

A

misalignment of the eyes (stable ocular alignment is not present until 2-3 months) –> normal alignment by 4 months of age

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19
Q

Esotropia

A

deviation inwards (strabismus)

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20
Q

Exotropia

A

deviation outward (strabismus)

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21
Q

How is strabismus dx?

A

corneal light reflex test
cover-uncover test
convergence test

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22
Q

What is the treatment for strabismus?

A

path therapy - normal eye is covered to strengthen the other eye
corrective surgery

if not treated before 2yo, amblyopia may occur (decrease visual acuity d/t cortical suppression of the vision of an eye)

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23
Q

Tympanic membrane infection

A

otitis media

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24
Q

How does otitis media present?

A 
preceded by viral URI commonly 
ear pulling doesnt increase pain 
loss of light reflex 
fever, otaliga, ear pulling 
CHL
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25
How is OM dx?
GOLD standard = pneumatic otoscopy (or tympanogram)
26
How and when do you tx OM?
ALWAYS tx <6mo almost always tx 6mo - 2yo (unless unilateral?) tx: Amoxicillin (80 - 90 mg/kg/day) augmentin if persistent or recurrent
27
Swimmers ear
otitis externa MC caused by psuedomonas digital trauma: staph aureus
28
What is malignant otitis externa?
osteomyelitis at skull base secondary to pseudomonas --> MC in DM or immunocompromised pts tx: ceftrazidime or piperacillin + floroquinolone or aminoglycoside
29
What is the treatment for otitis externa?
ciprofloaxacin + dexamethasone
30
What is the tx for OE with perforation?
ofloxacin
31
How does mastoiditis present?
looks like acute OM + swelling @ mastoid anteriorly rotated ear fever, mastoid tenderness
32
What is the treatment for mastoiditis?
CT scan
33
What is the treatment for mastoiditis?
hospital admission IV ceftraixone possible surgical decompression
34
How is TM perforation dx?
clinical dx - otoscope Weber lateralized to the affected ear in connective hearing loss
35
When is the earliest that one might see allergic rhinitis?
10-12 months a the earliest
36
What is the treatment for allergic rhinitis?
loratidine (claritin) fexofenadine (allegra) desloratidine cetirizine fluticasone (intranasal steroids): best medication for congestions and post-nasal drip Decongestants should NOT be used for >3-5 days d/t risk of rhinitis medicamentosa (rebound congestion)
37
What is the treatment for bacterial sinusitis?
amoxicillin | used only if sxs have been present for >10 days
38
What are the different types of antihistamines?
H2 inhibitors: - Cimetidine (Tagamet) - Ranitdine (Zantac) - Famotidine (Pepcid) H1 blockers (first gen): - chlorpheniramine (chlortrimeton) - diphenhydramine (benadryl) - dimenhydrinate (dramamine) H1 blockers (second gen): - Loratadine (Claritin) - Cetirizine (Zyrtec) - Fexofenadine (Allegra)
39
Who gets thrush?
infants, neonates, immunocompromised | pts on ABX and steroids
40
What is the tx for thrush?
Nystatin
41
What is the most common cause of peritonsillar abscess?
S. pyogenes (group A strep) S. aureus post URI unilateral abscess formation in the soft tissue of the deep neck tonsillitis --> cellulitis --> abscess formation
42
Hot potato voice
PTA
43
What is the gold standard for dx PTA?
needle aspiration neck CT with IV contrast
44
What is the treatment for PTA?
emergency referral to ENT surgical I&D post-op ABX: ampicillin-sulbactam IV then augmentin x 14 days
45
What causes retropharyngeal abscess?
S. aureus and S. pyogenes
46
Who gets retropharyngeal abscesses?
<5 yo
47
How does retropharyngeal abscess present?
odynophagia, stridor, drooling, torticollis
48
How is retropharyngeal abscess tx?
hospitalization and consult with ENT | IV ABX: ampicillin-sulbactam or clindamycin
49
What is the MC cause of pharyngitis?
50% are viral
50
What bacterial pathogens cause pharyngitis?
group A beta hemolytic strep
51
What is the classic presentation of pharyngitis?
sore throat, fever, HA, malaise, N Sandpaper rash - starts on neck or trunk - then spreads to extremities NO rhinorrhea or cough
52
Scarlet fever
sandpaper rash starting after 1-2 days after fever - starts on neck, then spreads to trunk and extremities strawberry tongue (white then red) Rash will last for 4-5 days
53
Centor Criteria
determining whether or not to test for strep ``` age: 3-14yo absence of cough tonsillar exudates or swelling temperature >38C anterior cervical LAD ```
54
RBC casts
glomerulonephritis - a complication of strep throat
55
Jones criteria
acute rheumatic fever occurs 3-4 weeks after strep infection Major: - carditis - polyarthritis - chorea - erythema marginatum - subcutaenous nodules Minor: - clinical: fever, arthraliga - lab: ESR, CRP, leukocytosis
56
What is the tx for strep?
PCN or Amoxicillin x 10d
57
What is the tx for strep if pt is allergic for PCN?
azithromycin, cefdinir x 5 days
58
PANDAS
pediatric autoimmune neuropsychiatric disorders associated with Strep infections strep infection triggers a misdirected immune response --> resulting in inflammation in the brain hallmarks: sudden onset of intense anxiety and mood lability accompanied by OCD-like issues and/or tics
59
What is the MC pathogen causing epiglottitis?
H. flu involves soft tissue above vocal cords
60
How is epiglottitis dx and tx?
Thumb print sign on lateral neck Xray definitive dx is made by direct inspection or cherry red and swollen epiglotisis --> observed when securing airway in the OR (intubation) Augmentin IV vanc + ceftriaxone x 7-10 days

EOR 3 - Peds (9 decks)

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