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HEENT 1 Flashcards

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1
Q

meibomian gland dysfunction

A

bhepharitis

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2
Q

what causes blepharitis

A

staphylococcus

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3
Q

treatment of blepharitis

A

Depends on the cause… Local steroid and antibiotic ointment applied at night

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4
Q

what causes hordeolum

A

staph infection

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5
Q

this is painful. externally, located in the glands of Zeis. Internally it is located in the meibomian glands

A

Hordeolum

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6
Q

Obstruction/inflammation in a meibomian gland, lump seen over the tarsal plate. Tend not to hurt

A

chalazion

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7
Q

watery, discharging eyes in first few months of life, plus or minus conjunctival redness

A

nasolacrimal duct obstruction

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8
Q

what bug causes nasolacrimal duct obstruction

A

staph and strep

HOWEVER, this is usually just a blockage rather than infection

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9
Q

cause of viral conjunctivitis

A

adenovirus

coxackievirus and enterovirus

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10
Q

Findings: red, dry eye starts unilaterally and spreads. Watery discharge, tender preauricular lymph node. Can present with cold sxs

A

viral conjunctivitis

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11
Q

Findings: red eyes bilaterally, pruritis, muco-purulent discharge, no cold symptoms

A

bacterial conjunctivitis

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12
Q

what causes bacterial conjunctivitis

A

Staph aureus, (s pneumo, H influ)

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13
Q

treatment for bacterial conjunctivitis

A

Topical erythromicin, polymixin-bacitracin, sulfacetamide, fluoroquinolones

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14
Q

neonatal conjunctivitis that can lead to permanent eye damage if not treated immediately

A

Opthalmia neonatorum

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15
Q

Cause of opthalmia neonatorum

A

organisms from the birth canal- Chlamydia or gonorrhea (e coli, HSV)

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16
Q

treatment for opthalmia neonatorum

A

SYSTEMIC antibiotic

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17
Q

Would you do cultures for conjunctivitis?

A

No, usually self limiting and respond well to treatment. EXCEPT in neonates, culture for G/C

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18
Q

Findings: itchy, watery eyes B/L. No injection. Cobblestone papillae on tarsal conjunctiva. Often presents with lid edema, nasal congestion/sneezing

A

allergic conjunctivitis

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19
Q

A patient with allergic conjunctivitis complains of photophobia and reduced vision. What do you think? What do you do?

A

Think corneal involvement- VERNAL conjunctivitis. Refer to opthalmologist

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20
Q

You see eosinophils in a conjunctival scraping. What is your dx?

A

allergic conjunctivitis

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21
Q

therapy for allergic conjunctivitis

A

Topical solutions combining antihistamine and mast cell stabilizers (can be OTC)
Antihistamine plus vasoconstrictors- Naphcon A
Liquid tears, oculoluberants

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22
Q

inflammation of the cornea

A

keratitis

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23
Q

common cause of keratitis

A

viral- HSV, N gonorrhea, adenovirus

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24
Q

You see a branching, dendritic ulcer. What do you think?

A

Herpetic keratitis

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25
treatment for herpetic keratitis
ocular acyclovir | refer to opthal
26
I am going to use ocular corticosteroids to treat keratitis. Am i smart? why or why not?
NO. Corticosteroids are contraindicated for they cause rapid progression and can lead to corneal perforation
27
two complications of keratitis
corneal scarring | iritis/deep keratitis (EMERGENCY)
28
how can i see corneal abrasions?
fluorescein exam
29
treatment for corneal abrasion
antibiotic drops | patching the affected eye
30
what is likely to infect a corneal abrasion?
staph
31
pt has RA, sjogren, SLE, or polyarteritis nodosa and presents with eye complaint. What are you worried about?
corneal ulcer
32
Blood in anterior chamber of eye (trauma, glaucoma, vascular abnormalities
Hyphema
33
treatment hyphema
Usually an emergency... refer to opthal. Must suspect abuse in a child
34
Increased IOP creating pain, damage to eye structures resulting in progressive vision loss
glaucoma
35
three infective reasons for cataracts
Intrauterine Rubella, CMV, congenital varicella
36
Pts eye exam revels leukocoria, strabismus, nystagmus, and poor fixation
cataract
37
two metabolic resons for cataracts
diabetes, galactosemia
38
decrease in the child’s vision that can happen even when there is no problem with the structure of the eye
amblyopia
39
treatment of amblyopia
patch the good eye to make the other one get better
40
three types of amblyopia
strabismic deprivation refractive
41
any misalignment of the eye. Usually result of an abnormality of NM control of eye movement
strabismus
42
four types of strabismus
esotropia, exotropia, hypotropia, hypertropia
43
strabismus: cranial nerves that can be involved
III IV
44
Oscillatory movement of eyes, may be horizontal, vertical or torsional/rotational
nystagmus
45
common reasons for nystagmus in kids
Congenital: neuro dysfunction Acquired: vestibular lesions/inflammation/infection
46
Neovascularization of immature eye vasculature seen in preemies
Retinopathy of prematurity
47
ROP can result in
retinal detachment and vision loss
48
most common cause of otitis externa
``` pseudomonas aeuruginosa (staph aureus) ```
49
treatment for otitis externa
Topical –2% acetic acid to restore ph …. Or antibiotic / corticosteroid drops . Common to use fluroquins like Cipro
50
Ear exam: TM is grey, air fluid levels present, bubbles, little to no movement of TM, TM retracted
Otitis media with effusion
51
usually caused by a non-infectious fluid level behind the TM. no pain, no fever. Hearing loss, fullness of ear, vertigo (maybe)
OME
52
contributing factors to OME
allergic rhinitis tonsillar/adenoid hypertrophy sinusitis eustacian dysfunction
53
Kid with tons of post nasal drainage and a URI complains of ear pain, fullness, popping sensation and decreased hearing
Eustacian dysfunction
54
Kid comes in: poor feeding, fever, pain, crying, pulling on ear
AOM
55
Otoscope reveals red, bulging TM, impaired visibility of landmarks, bullae, (red, white yellow)
AOM
56
Triad of findings: AOM
- Recent abrupt onset of illness (URI) - Signs/sxs middle ear inflammation (otalgia, crying, otorrhea, fever) - Otoscopic findings (evidence of effusion)
57
common bacterial bugs for AOM
s pneumo, h influ, moraxella catarrhalis
58
common viral etiologies for AOM
RSV, influenza, (rhinovirus, coronavirus, parainfluenza, adenovirus, enterovirus)
59
Kid comes in less than 6 months. You diagnose with AOM. treatment?
antibacterial therapy
60
1 year old comes in, you think he has AOM but arent sure bc its not severe. Treatment?
observation
61
1.5 year old comes in. You diagnose with AOM. Treatment?
antibacterial therapy
62
7 year old comes in. You think he has AOM but arent sure. Treatment?
Observation
63
3 year old comes in. Has non-severe AOM. Treatment
Observation
64
first line for AOM antibacterial therapy
Amoxicillin 90mg/kg/day for 10 days
65
second line tx for AOM
Amoxicillin-clavulante 90mg/kg/day of amox component for 7-10 days
66
second line treatment for AOM fails. Now what
Ceftriaxone 50mg/kg dose parenterally for 1-3 days
67
Pt is allergic to amox.. what else can i use to tx AOM
Cefdinir, cefpodoxime, cefuroxime, azithromycin, or clarithromycin
68
When would you consider using PE tubes?
Chronic OME with conductive hearing loss Failed tx for recurrent AOM (they dont prevent ear infections)
69
is AOM usually viral or bacterial?
VIRAL
70
most common organism for mastoiditis
Strep pneumo and strep pyogenes
71
Pt comes in with postauricular pain, fever, displacement of pinna
mastoiditis
72
complication of mastoiditis
meningitis | brain abscess
73
Treatment for mastoiditis
Myringotomy to obtain culture. Hospitalization with IV ABX (ceftriaxone and nafcillin or clindamycin). If severe, corticalmastoidectomy
74
Growing mass of epithelial tissue within middle ear and temporal bone
cholesteatoma
75
complications of cholesteatoma
permanent hearing loss, abscess, (sever morbidity and mortality if untreated)
76
treatment for cholesteatoma
surgical removal
77
Most common cause of conductive hearing loss in children
OM
78
this type of hearing loss is due to defect in cochlear receptor cells or auditory nerve (CN VIII). RFs include LBW, low APGAR, hypoxia, TORCH, kernicterus
sensorineural hearing loss
79
Aquired SNHL can come from which infections
CMV, meningitis, syphillis, lyme disease
80
Which drug can cause SNHL
gentamicin
81
Are you concerned: Kid has no teeth at 10 months
NO (15 months is a concern)
82
Are you concerned: teeth arent coming out in pairs
YES. we want mirror patterns
83
Natal teeth, what are we worried about?
Often have no roots and can fall out, aspiration risk
84
most common cause of gingivits and caries
strep viridians
85
kid shows up with10+ small mouth ulcers on buccal mucosa, anterior pillars, inner lips, tongue, gingiva (not posterior pharynx). What do you think?
HSV
86
Treatment for HSV
treat symptoms, if caught early could start oral acyclovir 20mg/kg QID x 5days (no corticosteroids)
87
Kid shows up with ulcers in the mouth that looks like apthous ulcers, but he has a fever. what do you think?
HSV stomatitis
88
what causes thrush?
candidia albicans
89
Kid shows up refusing to feed, with white curd like plaques on inner cheeks that bled when they were scraped off
Thrush

Pediatrics (15 decks)

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