General pediatrics Flashcards
(101 cards)
1
Q
What is the most common neck masses?
A
Thyroglossal duct cysts
2
Q
What is the second most common neck masses?
A
Brachial cleft
3
Q
Rx for thyroglossal duct cyst
A
surgical excision
4
Q
Post-op carefor thyroglossal cyst
A
Thyroid scan
5
Q
What happens to cyst during URI?
A
Get larger
6
Q
Which neck mass transilluminates?
A
cystic hygroma - lymphangioma
7
Q
Rx lymphangioma
A
Resection vs sclerotherapy
8
Q
With how many hemangiomas will you need to search for internal hemangiomas?
A
5
9
Q
Pattern: a mass over sternocleidomastoid
A
torticollis
10
Q
Pattern: larger with crying/valsalva
A
hemangiomas and cervical lung herniation
11
Q
Most common bacteria cuase of lymphadenitis?
A
strep and staph
12
Q
Rx for reactive lymphadenopathy
A
can observe for 3 to 4 weeks if asymptomatic and no concerning features or empiric antibiotics
13
Q
Concerning features for acquired neck mass
A
- Persists >8-12 weeks
- Firm, rubbery, non-mobile, non-tender, matted
- Growing or >2cm in children or 1.5cm in adolescents
- Supraclavicular mass because they drain mediastinum, lungs and abdomen
- Systemic signs/symptoms
14
Q
Workup for acquired neck mass
A
CBC, ESR, LDH, uric acid, PPD, EBV, CMV, HIV, Bartonella, US, CXR
15
Q
What age is monospot best for
A
> 4yo
16
Q
First line abx for lymphadenitis
A
clindamycin, augmentin, cephalosporin
17
Q
Abs for Bartonella
A
azithromycin, doxycycline or quinolone
18
Q
Hearing loss dB and qualitative scale:
Miss up to 50% speech, may seem disinterested, or dx’ed wth ADHD
A
20-40dB; mild hearing loss
19
Q
Hearing loss dB and qualitative scale:
Miss >50% speech, poor expressive language
A
40-70dB; moderate hearing loss
20
Q
Hearing loss dB and qualitative scale:
Miss 100% normal volume speech, poor or absent expressive verbal language
A
70-90dB; severe hearing loss
21
Q
Hearing loss dB and qualitative scale:
Sound vibrations are felt
A
> 90dB sound vibrations are felt
22
Q
Syndromes associated with hearing loss
A
Goldenhar, Treacher Collins’ (AD), Down
23
Q
Pattern: long QT + SNHL
A
Jervelle Lange-Nielsen
24
Q
Pattern: Retinitis pigmentosa + SNHL
A
Usher syndrome
25
Pattern: glomerulonephriis + high frequency SNHL
Alport's
26
Pattern: pigment defects (white forelock), SNHL
Waardenburg
27
Pattern: Goiter + SNHL +/- balance problems
Pendrid syndrome
28
Pattern: bone fragility and SNHL
osteogenesis imperfecta type 1
29
Maternal medication + SNHL
alcohol, isotretinoin, cisplatin
30
Medications children take that causes SNHL
aminoglycosides, furosemide, vancomycin
31
Pattern: SNHL + vertigo
perilymphatic fistula from trauma
32
Pattern: conductive hearing loss on SNHL
abnormal bone and air conduction, but bone >10dB better than air conduction
33
Pattern: Abnormal bone and air conduction but each within 10dB of each other
SNHL
34
Will infants with profound deafness startle, laugh and babble
yes
35
Hearing loss after what yr is less poor prognosis
5yr
36
Most common non-sydromic genetic HL
connexcin 26 gene defect, AR bilateral, mod/sever
37
Most common congenital infection SNHL
CMV
38
Most common acq infection that leads to SNHL
Meningitis
39
Pattern: abnormal bone and air conduction
SNHL (within 10dB of bone) CMV and meningitis
40
Pattern: abnormal bone and air conduction (>10 dB worse than bone)
Mixed HL - multiple factors
41
When is the universal screening age for newborns?
screening by 1 mo, confirm by 3 mo, receive early intervention by 6 months
42
What kind of hearing loss is identified by newborn screens
moderate/severe hearing loss, not ild (<40dB)
43
OAE or BAER
| Cannot tell degress of hearing loss, just pass/fail
OAE
44
OAE or BAER
| Can estimate ear specfic thresholds
BAER
45
OAE or BAER
| Neurologic function. ability to hear is inferred
BAER
46
Describe behavioral observation audiometry exam
Placed on parent's lap, stimuli with external speakers, look for change in child's behavior, no threshold or ear specific info is obtain
47
What can behavioral observation audiometry tell you?
Exclude profound hearing loss
48
Describe visual reinforcement audiometry (VRA)
Same as BOA, but observe child to look for sound 6mo to 3 years old
49
Describe conditioned play audiometry
Headphones provide ear specific information, ask child to do play task in response to sound
3 to 5 years old
50
Pure-tone audiometry
tests air and bone conduction, distinguish CHL, SNHL and mixed hearing loss
51
Static admittance (compliance) peaks at what pressure
P = 0
52
Normal volume is for tympanometry is what?
0.5 to 1.5ml
53
Less comcompliant ear drum cause
early effusion
54
Too compliant ear drum
Thin ear drum or healing
55
Pattern: poorly compliant TM normal volume
likely middle ear effusion
56
Pattern: poor compliant, low volume
cerumen impaction or probe against canal wall
57
Pattern: poor compliant, high volume
TM perforation or tympanostomy tubes
58
Pattern: peak compliance at negative pressure
Retracted TM (URI, eustachian tube dysfunction)
59
Age that will ensure best outcome with cochlear implants
<2yo
60
What are children with cochlear implants are most at risk for?
PPSV-23
61
What organism has the highest resistance to PCN that causes otitis media?
M. catarrahlis
62
What are the three most common bacterial because of AOM?
S pneumonia, H influenzae, M catarrhalis
63
Most common 4 viruses of AOM?
RSV, rhinovirus, influenza, parainfluenza, adenovirus
64
What are some risk factors for AOM?
<2yo, day care, allergy/atopy, bottle eeding, not breastfeeding, first AOM <6 months of age, immune deficiency, craniofacial anomalies (cleft palate)
65
To treat or not to treat?
| Bilateral non-severe <2yrs
Treat
66
To treat or not to treat?
| Unilateral non-severe <2yrs
observe
67
To treat or not to treat?
| bilateral >2yrs
observe
68
To treat or not to treat?
| Unilateral non-severe >2yrs
observe
69
Rx AOM?
Amoxicillin 80-100mg/kg for 10 days
70
If patient doesn't respond within 48hrs of amoxicillin treatment, then what?
Augmentin
71
If if AOM doesn't respond to 2nd line, then what?
ceftriaxone IM/IV x 3 days
72
Rx for PCN allergic pt
3rd gen cephalosporin or +clindamycin
73
Why can't you use clindamycin for AOM?
lacks H influenza activity
74
Why can't you use macrolides for AOM
limited S pneumonia, H influenza activity
75
What can't you use bactrim for AOM
very limited S pneumonia
76
Augmentin is reasonable 1st line under what circumstances?
Amox within last 30 days for any purpose; conjunctivitis (H influenzae), h/o of recurrent AOM unresponsive to amoxicillin
77
Follow-up plan for AOM treatment
2-3 months for child <2 years old; >2 years old if language/learning concerns
78
When would you consider tympanostomy tube?
>4 AOM/year
79
Describe otitis media with effusion
Fluid in middle ear without signs/symptoms of acute ear infection, pneumatic otoscopy, decreased TM mobility, cloudy TM, air fluid levels
80
Management of OME?
If has risk factors, then check hearing and refer to ENT if abnormal
1) previous permanent hearing loss
2) speech/language delay
3) developmental delay
4) Syndromes or craniofacial disorders
5) cleft palate
6) blindness
81
In patient with OME, at not at high risk, how do you manage
recheck in 3 months
82
Define chronic suppurative otitis media
purulent otorrhea assoicated with chronic TM perf for >6 weeks
83
What is most common organism for chronic suppurative otitis media?
P aeruginosa, S aureus, enteric GNRs
84
Rx suppurative otitis media
topical ciprofloxacin
85
What is the most common agent for otitis externa
P aeruoginosa, S aureus, often polymicrobial
86
Rx for otitis externa
topical quinolones polymixin or aminoglycoside
87
Rx of perforated TM or tympanostomy tube
non-toxic topical antibiotics
88
What is the biggest risk factor for bacterial sinusitis?
viral uri
| followed by allergic rhinitis
89
When do the following sinuses develop?
Ethmoid/maxillary - present at birth, sphenoid 5 years, frontal 7 years
90
Define acute bacterial sinusitis
<30 days
91
Define subacute bacterial sinusitis
30-90 days
92
Define chronic bacterial sinusitis
>90 days
93
Define recurrent acute
multiple episodes of acute with at least 10 days asymptomatic in between
94
Define bacterial sinusitis persistent illiness presentation
nasal discharge, daytime cough or both for >10 days without improvement
95
Define bacterial sinusitis severe onset presentation
concurrent T >39 and purulent nasal discharge >3 days
96
Define bacterial sinusitis worsening course
worsening or new onset nasal discharge, daytime cough, fever after initial improvement
97
Causes of chronic sinusitis
same as acute, s aurueus or fungi
98
Dx of of acute bacterial sinusitis
aspiration
99
Rx for persistent acute sinusitis
observation ok for 72 hours, then antibiotics
100
Rx for severe onset or worsening
start antibiotics - amox or augmentin
101
Start with Augmentin
day care attendance, amoxicillin within last 30 days, <2yo
