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Phase 2 PEDs > ENT/Resp basics > Flashcards

ENT/Resp basics Flashcards

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1
Q

Ambylopia is?

A

Central vision loss due to bad development

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2
Q

Types of Ambylopia?

A

Strabismus
Refractory
Deprivation

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3
Q

Ambylopia due to Strabismus attributes?

A

Misalignment - brain ignores input from bad eye

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4
Q

Ambylopia due to Refractory attributes?

A

Vision blurry

  • Myopic - near-sighted
  • Hyperopic - far sighted
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5
Q

Ambylopia due to Deprivation attributes?

A

Vision obstructed

  • Retinopathy of prematurity
  • Congenital cataracts/glaucoma
  • Retinoblastoma (w/ leukocoria)
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6
Q

When is complete ophthalmologic exam is necessary?

A

Premature birth
Hx cerebral palsy/downs
Poor school performance

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7
Q

Reasons to refer to Ophthalmology?

A

Any - Nystagmus, Strabismus, Acuity >20/40 either eye after 3yo or 2 line difference on eye chart.
ABNL Red reflex
Torticollis that is unexplained

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8
Q

MC cause of conjunctivitis per timing of onset in neonate?

A 
Day
1-3 - Chemical
2-7 - Staph/Strep, Pseudomonas, E. Coli
3-21 - HSV
4-19 - C. Trachomatis
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9
Q

Types of conjunctivitis?

A

Neonatal
Infectious
Allergic
Chemical

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10
Q

Dx of HSV neonatal conjunctivitis?

A

Dendritic lesions on cornea

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11
Q

N. Gono infection Prevention?

A

Prph silver nitrate
OR
Erythromycin - Tetracycline ointment after birth

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12
Q

TXT of C. Trachomatis conjunctivitis?

A

(po) Erythromycin x14d

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13
Q

TXT of Gonorrhea conjunctivitis?

A

Ceftriaxone (IV) or (IM) once and ADMIT

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14
Q

TXT of HSV conjunctivitis?

A

Acyclovir + refer

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15
Q

TXT of S.A conjunctivitis?

A

(Top) Abx - Erythromycin or Polysporin

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16
Q

TXT of Pseudomonas conjunctivitis?

A

(Top) FQ - moxifloxacin or ciprofloxacin

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17
Q

Indications of viral conjunctivitis?

A

Pre-auricular node

Watery eye unilateral > bilateral

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18
Q

MC organism of viral conjunctivitis?

A

Adenovirus (Pink eye)

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19
Q

TXT of viral conjunctivitis?

A

Supportive/hand wash and cool compress

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20
Q

How to distinguish Bacterial from Viral conjunctivitis?

A

Bacterial - Purulent Discharge - Wipes frequently

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21
Q

TXT of HIB, S. Pneumo, M. Catarrhalis conjunctivitis?

A

(Top) Abx - Erythromycin, polymyxin, b-trimethoprim

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22
Q

What should be initial TXT of any conjunctivitis?

A

Gentle massage w/ warm moist washcloth

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23
Q

Polytrim ABX for conjunctivitis is? Form? Rx?

A

Ophth drops OF - Polymyxin B and Trimethoprim

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24
Q

Erythromycin for conjunctivitis is? Form?

A

Ointment

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25
(PO erythromycin is used for what type of conjunctivitis?
C. trachomatis
26
Allergic conjunctivitis presents as?
Bilateral - Pruritus - Watery DC - Cobble-stoning eyelid edema - Blebs
27
TXT of allergic conjunctivitis?
``` (Top) V-con, NSAIDs, AH Blepharitisor (Top) Cromolyn or (PO) AH ```
28
How far does erythema/injection extend w/ conjunctivitis?
Stops before limbus
29
Blepharitis is?
Eyelid margin inflammation due to bacteria or dysfx of seborrhea/Meibomian glans
30
TXT of Blepharitis is?
Gentle cleanse (Johnson baby shampoo) and warm compress OR (Top) Abx - Bacitracin - Erythromycin
31
MC bacteria causing Blepharitis?
S.A.
32
Dacrocystitis is classified as?
Acute - complete block | Chronic - Partial blk (dacryostenosis)
33
Dacrocystitis is usually due to what organism?
S.A or coag = staph
34
TXT of Acute Dacrocystitis?
(PO) systemic Abx
35
TXT of Chronic Dacrocystitis?
Warm compress AND (Top) ABx
36
Complication of Dacrocystitis?
Orbital cellulitis
37
Hordeolum is?
External (Stye)- infected Zeis glands of eye lash follicle Internal (Stye)- infected Meibomian gland - Painful and RED
38
Hordeolum (Stye) MC organism?
Staph (TTP and RED)
39
TXT of Hordeolum?
Warm compress freq NSAIDs Refer - 1-2w if no resolution
40
Chalazion is?
Meibomian gland obstruction | - NOT painful or RED
41
Meibomian gland difference between Hordeolum and Chalazion?
Hordeolum - Internal stye = Infected Meibomian gland | Chalazion - Obstructed Meibomian gland
42
TXT of Chalazion?
SML - warm compress - SL wk-mo | No resolution or symptomatic - Refer CCS Inj or surgery
43
What is a serious complication of Sinusitis?
Orbital cellulitis
44
Orbital cellulitis is?
Bacteria spreading into orbit through infected sinus wall
45
Organisms ass/w Orbital cellulitis?
S.A, Strep pneumo, HIB
46
Which is a true emergency Orbital cellulitis or preseptal (periorbital) cellulitis?
Orbital cellulitis
47
TXT of Orbital cellulitis?
``` Admit - Blood cx - CT (surgery) IV Abx - Cefazolin OR Clindamycin OR - Cefuroxime + metronidazole OR - MRSA - Vanc + cefotaxime + clindamycin ```
48
RED flags of Orbital cellulitis?
``` Fever Painful extraocular motion LROM of eyes Exophthalmos Vision changes Chemosis ```
49
Complications of Orbital cellulitis?
Cavernous sinus thrombosis Subperiosteal abscess Vision loss
50
Preseptal (periorbital) cellulitis MC occurs in what pop?
<3yo
51
Which cellulitis of eye has pain/exophthalmos?
Orbital cellulitis - NOT preseptal cellulitis
52
Preseptal (periorbital) cellulitis is ass/w what MOI?
Skin lesion or trauma
53
MC organism of Preseptal (periorbital) cellulitis?
S.A or GAS
54
TXT of Preseptal (periorbital) cellulitis?
Outpt TXT w/ daily f/u - Augmentin or Cephalexin or Clindamycin - MRSA - TMP-SMX or Clindamycin
55
Congenital anomalies ass/w AOM?
Cleft palate, Downs, HIV PEDs
56
Pathogens MC to AOM
Bacteria - S. Pneumo, HIB, M. Catarrhalis, GAS | Viral - Rhinovirus, Influenza, RSV
57
AOM Dx requires what 3 things?
Acute onset S?S Mid Ear Effusion Mid Ear Inflammation
58
Other S/S of AOM?
Bulging TM - opaque or hyperemia Decreased mobility of TM TM air-fluid level
59
Uncertain AOM can use what to help Dx?
Tympanometry - good seal/technique
60
What is OME?
Effusion w/ otitis media - but w/out acute S/S | - common in 1st 2yr of life
61
MC freq sequela of AOM?
OME
62
TXT of AOM?
Abx 1L - Amoxicillin 2L - Augmentin 3L - Ceftriaxone (IM) - Cefdinir, Cefuroxime axetil
63
AOM complications?
``` Unresolved after months Conductive hearing loss - Speech delay Mastoiditis Cholesteatoma Petrositis Intracranial invasion ```
64
When is pressure equalization tubes considered for AOM?
PEDs w/ developmental risks or Recurrent AOM + 3mo persistent effusion w/ bilateral hearing loss.
65
Mastoiditis S/S?
Posterior auricular TTP, edema, red + AOM | Pinna is displaced down/out
66
Mastoiditis TXT?
Systemic Abx and ENT to I/D
67
Cholesteatoma is?
Mass like keratinized epithelial growth | ENT refer
68
Recurrent OM in <1mo requires?
Abx change
69
Recurrent OM over >1mo requires?
Can use same Abx
70
Prph Abx considered in Recurrent OM if?
>3 episodes in 6mo or >4 episodes in 12mo
71
Prph Abx used for Recurrent OM?
Amoxicillin Q/d at night | Sulfisoxazole Q/d at night
72
Indication for ENT referral concerning Recurrent OM?
Recurrence while on PRPH Abx >3mo effusion Speech/hearing delay - >3 AOM episodes w/in 6mo OR >4 AOM episodes 12mo
73
When are tympanostomy tubes inserted?
Recurrent OM - >3 AOM epsiodes w/in 6mo or - >4 AOM episodes w/in 12mo
74
Otitis Externa is AKA?
Swimmers Ear
75
Otitis Externa is?
External auditory canal inflammation w/ exudate
76
MC organisms ass/w Otitis Externa?
``` P. aeruginosa - (ass/w swimming) or S.A. or Tubes - expands potential organisms ```
77
Otitis Externa presents as?
Ear pain, TTP, discharge Pinna/Tragus TTP (esp. if chewing) Canal - red/edema TM- usually NL
78
Otitis Externa TXT?
(Top) - antimicrobial + CCS otic agent - Ofloxacin or Ciprofloxacin + Hydrocortisone or Dexamethasone - Polymyxin B - Hydrocortisone
79
PVT of Otitis Externa?
Avoid vigorous cleaning of canal | Dry ears after swimming/showering - Acetic acid/diluted rubbing ETOH/ burrow solution
80
MC attributes of Epistaxis?
6-10yo - Late fall or Winter
81
Epistaxis pathology?
Dry friable mucosa at KIESSELBACH Plexus
82
Epistaxis causes?
``` MC - Digital trauma URI/AR FOB Bleeding d/o Dry air ```
83
Initial TXT of Epistaxis?
Sit pt up - direct pressure pinching x10m
84
Persistant Epistaxis w/ identifiable source TXT?
Cauterize w/ silver nitrate or aluminum chloride
85
Persistant Epistaxis w/ NO source TXT?
Afrin spray or Afrin ointment soaked gauze, phenylephrine, lidocaine PACK!
86
Severely persistant Epistaxis and all TXT failed?
Anterior nasal packing in place 2-3d and Prph Abx - Augmentin OR TMP-SMX
87
When is ENT referral considered for Epistaxis?
Persistant bleeding or located posteriorly
88
Complication of Epistaxis packing?
Septal necrosis
89
PVT of Epistaxis?
Avoid trauma Humidifer, Vaseline around nares TXT underlying conditions
90
Common Cold etiology?
MC - Rhinovirus | - Coronavirus > RSV > Flu > Paraflu > Adenovirus
91
Common cold resolves when?
7-10d
92
Complications of common cold?
OM or Bacterial sinusitis
93
Common presents as?
Nasal congestion/rhinorrhea Sore/Scratchy throat +- non-productive cough
94
TXT of common cold?
Symptomatic Antipyretics - fever NO - AH, decongestants <6yo Or NO Abx, cough suppressants and expectorants
95
Sinuses present at birth?
Maxillary and Ethmoid
96
When does other sinuses develop?
Sphenoid - 5yo | Frontal - 7yo > Adolescence
97
What are ostia?
Narrow Openings 1-3mm that drain sinuses into middle meatus (AKA. Ostiomeatal complex)
98
Are sinuses a sterile environment?
YES
99
Sinusitis is?
Obstruction of mucociliary flow impeding drainage allowing for bacterial infection
100
Pathogens ass/w acute Sinusitis?
S.A. - GAS - S. Pneumo M. Catarrhalis HIB
101
Pathogens ass/w SUB-acute Sinusitis?
Anaerobes
102
Common Sinusitis manifestations?
Lasts >10-14d w/out improvement Mucopurulent rhinorrhea Nasal stuffiness Cough at night
103
Other Sinusitis S/S possibly present?
Voice is nasal Bad breath Facial swelling/TTP HA
104
Most accurate Dx of Sinusitis?
Sinus aspiration - not necessary usually | - CT/MRI
105
TXT of Sinusitis?
1L - Augmentin 14d - high dose therapy if - 1. had ABX last 3mo 2. <2yo, 3. resistant patterns in area 2L - Levofloxacin (Type 1 HSN rxn to PCN) or 2L - Clindamycin + Cefixime or Cefpodoxime (Non-type 1 HSN rxn to PCN)
106
Allergic rhinitis is AKA?
Hay fever
107
Allergic rhinitis S/S?
Sneeze Itch Nasal congestion/Drainage
108
Types of Allergic rhinitis?
Seasonal - pollen Perennial - Indoor allergens Episodic - Only if exposed to that environment
109
Allergic rhinitis is what type of rxn?
IgE mediated allergic response
110
Allergic rhinitis pathophys occurs how?
Early phase - Mast cells degranulate > histamine, PG, leukotrienes Late phase (4-8h later) - EOS, BASO, CD4, Mono, SEGs > - Mediators released > - Nasal inflammation and PLT activating factor
111
Allergic rhinitis is ass/w what other conditions?
Atopic triad - Eczema - Asthma - Allergic rhinits
112
Stand out findings w/ Allergic rhinitis?
Pruritis Cobble stoning Allergic shiners Transverse nasal crease
113
Rhinitis medicamentosa is?
Overuse of (top) nasal decongestants
114
TXT of Allergic rhinits?
1. (IN) CCS - Fluticasone or Mometasone 2. (PO) AH - 1st gen (Benadryl/hydroxyzine) or (MC) - 2nd gen (Cetirizine, loratadine, fexofenadine) 3. (Top) AH - Azelastine or Olopatadine 4. Cromolyn or Neocromodil (QID dosing) 5. (2-3L) Montelukast (Leukotriene Recep antag) 6. Immunotherapy
115
Most potent Rx TXT for any Rhinitis?
(IN) CCS - Fluticasone or Mometasone
116
Decongestants used for Allergic rhinitis?
Pseudoephedrine or Phenylephrine
117
Rx specifically for non-allergic rhinitis OR rhinits ass/w viral URI?
(Top) Ipratropium Bromide nasal spray
118
Pharyngitis/Tonsillitis pathogens?
Viral - rhino, corona, adeno, HSV, flu, etc | Bacterial - GAS, Group C strep
119
Pharyngitis/Tonsillitis presents as?
Prominent sore throat Fever No URI S/S
120
Pharyngitis/Tonsillitis is uncommon in what population?
Before 2-3yo
121
Centor criteria?
1pt each - 1. No cough 2. TTP/Swollen Anterior cervical LAD 3. Fever 4. Swollen or exudative Tonsils 5. 3-14yo Results - 1-3 - Rapid/Cx > Abx IF positive - 4-5 - Rapid/Cx > Start empiric Abx
122
Gold standard for Strep Pharyngitis/Tonsillitis?
Strep Culture
123
If mononucleosis is part of DDx include what in eval?
Monospot AND CBC
124
TXT of Pharyngitis/Tonsillitis strep?
(PO) PCN V x10d (IM) PCN G Benz once - cephalexin, cefadroxil, clindamycin x10d - PCN allergy - Erythromycin x10d -or- Azuthromycin x5d - B-Lactam allergy
125
Why is Strep Pharyngitis/Tonsillitis TXT?
``` Shortens illness 12-24h PVTs complications (ENT, Acute RF) ```
126
What is not PVT during TXT of Pharyngitis/Tonsillitis?
PSGN
127
Local complications of Pharyngitis/Tonsillitis?
AOM, Sinusitis, Peritonsillar abscess
128
Systemic complications of Pharyngitis/Tonsillitis?
``` Toxic shock syndrome Scarlet fever PSGN RF - PANDAS - basal ganglia autoimmune inflammation causing OCD/tics (motor/vocal) ```

Phase 2 PEDs (23 decks)

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