HEENT 2 Flashcards
(100 cards)
1
Q
what is the Most Common Pediatric infectious disease
A
Viral rhinitis
2
Q
what is the most common cause of viral rhinitis
A
Rhino virus
3
Q
what are 4 other causes of viral rhinitis
A
influenza/parainfluenza/ RSV/adenovirus
4
Q
when does viral rhinitis most often occur
A
early vall to late spring
5
Q
what is the avg length of viral rhinitis? what is the progression
A
Avg 7 days , mucus clear mucoid day 2 from shedding of epithelial cells and influx of neutrophils
6
Q
what does color of mucus indicate in viral rhinitis?
A
Does not indicate bacterial – shedding of epithelial cells
7
Q
what is the common cold?
A
viral rhinitis
8
Q
what presents with Nasal congestion (rhinorrhea /nasal obstruction), +/- mild fever, +/- sore “scratchy” throat. Nose, throat, TM red + inflamed
A
viral rhinitis
9
Q
when does viral rhinitis become sinusitis?
A
> 10-14days
10
Q
how do you treat viral rhinitis? what is not recommended in children under 6?
A
Antihistamines. Decongestants and combo’s not recommended for children < 6 due to no benefit and potential bad effects
11
Q
what does allergic rhinitis contribute to ? 2
A
development of rhinosinusitis and asthma exacerbations
12
Q
what has symptoms of Nasal congestions, sneezing, rhinorrhea, itchy nose, palate, throat and eyes
A
allergic rhinitis
13
Q
what on PE hasNasal turbinates swollen, red or pale pink
A
allergic rhinitis
14
Q
what is tx of allergic rhinitis
A
Tx for symptoms
Intranasal corticosteroids, oral and intranasal antihistamines, decongestants
15
Q
what if a child <10 has nasal polyps?
A
suspect CF
16
Q
The majority of nose bleeds are due to ____
A
picking nose or putting something up there
17
Q
_____% of nose bleeds are due to bleeding disorder i.e Von Willebrand disease
A
5%
18
Q
The nosebleed usual arises from the ____ part of the nasal septum.
A
kiessellback plexus
19
Q
how do you treat epistaxis?
A
leaning forward, clear passages, pinch nose below nasal bones, pack with gel sponge or foam.
20
Q
what sinus is present at birth pneumatized ~ 4 yr
A
maxillary
21
Q
what sinus is present and pneumatized at birth
A
ethmoid
22
Q
what sinus is develop by the 5th or 6th birthday
A
sphenoid
23
Q
what sinus begin dev 7th or 8th birthday- not fully dev until adolescence
A
frontal
24
Q
when is frontal sinusitis unusual?
A
<10y/o
25
Does a child need a sinus x-ray
no not fully developed
26
what is Infection of paranasal sinuses; Almost always preceded by URI.
Rhinosinusitis (Sinusitis)
27
what has symptoms of Nasal drainage, congestions, facial pressure or pain, PND, fever, cough, fatigue, maxillary dental pain, ear pressure or fullness. HA
Rhinosinusitis (Sinusitis)
28
what 2 sinus's are affected in Rhinosinusitis (Sinusitis)
maxillary and ethmoid
29
on PE what has sinus tenderness with older children
Rhinosinusitis
30
what is the most common microb of sinusitis
strep pneumo
31
what are other causes of sinusitis?
Haemophilus influenzae
Moraxella catarrhalis
Viruses
Adenovirus, parainfluenza, influenza, and rhinovirus
32
what are the 2 least common causes of sinusitis
GAS and Staph aureua
33
when pt has not cleared infection in the expected amount of time
Sx + PE , + CT for some.
Mucosal swelling and obstruction from allergies
chronic rhinosinusitis
34
if a 15y/o has septal polyps and has allergies since 5 y/o what should you do
nothing-->does not indicate CF
35
what is Recurrence with each or most URI
chronic rhinosinusitis
36
when are plain films appropriate with recurrent ABS, vague symptoms, or a poor response to therapy
older children
37
what is first line treatment of ABS
Amoxicillin for 10-14 days -->7days after symptoms resolve
38
what is first line for chronic sinusitis?
vanco -->cover for staph
39
if child has a PCN allergy and ABS what should you use
cefuroxime axetil, cefpodoxime, macrolides
40
if amoxicillin fails in 72 hrs for ABS what should you use or recent tx with amox
Amoxicillin-clavulanate (Augmentin
41
when unresponsive to conservative therapy what do you do?
refer to ENT
42
what is the most common complication of rhinosinusitis
orbital cellulitis, Eyelid edema, restricted EOM, proptosis, altered visual acuity
43
what is Inflammation of eyelid tissues results from trauma or spread of local infections.
PreseptalCellulitis
44
what are the most common pathogens of PreseptalCellulitis
Staph aureus and Strep pyogenes
45
what is Inflammation of orbital tissues behind the orbital septum
orbital cellulitis
46
what may spread of orbital cellulitis cause 2?
Cavernous Sinus Thrombosis or Meningitis.
47
what are the common pathogens of orbital cellulits?
secondary to acute sinusitis – respiratory flora and anaerobes, staph aureus.secondary to ocular inflammation.
48
if orbital cellulits is due to sinusitis how do you treat
amox
49
if orbital cellulits is d/t staph a how do you treat
vanco
50
The 2 bacterial pathogens that play the largest role in acute otitis media are:
Haemophilis influenzae
| Streptococcus pneumoniae
51
You see a healthy 5-year-old girl with no significant past medical history in your office for ear pain that started last night. Her TM appears inflammed. She has no fever and is otherwise well. You diagnose acute otitis media. Your best initial management is:
Treatment with acetominophen for pain and follow-up in 2 to 3 days if no change in symptoms or is symptoms worsen
52
You are seeing a 15-month-old boy in your office for ear tugging, excessive crying, and fever of 39.5C. He is otherwise healthy though last month he received amoxicillin for treatment of AOM. Today you diagnosis AOM. He has no med allergies. Best management at this time includes
amoxicillin-clavulanate 80-90 mg/kg per day of the amoxicillin component
53
In considering empiric therapy for a 7-year-old boy in whom you suspect acute sinusitis, you should prescribe:
amoxicillin 80-90 mg/kg per day
54
Acute bacterial sinusitis is best distinguished from a viral upper respiratory tract infection by:
duration of symptoms for greater than 10 days
55
A diagnosis of acute bacterial sinusitis should be based on:
a precise clinical history regarding quality and duration of symptoms
56
A mother brings in her 2 yr old for a runny nose and bad breath. She denies fever / vomiting / diarrhea. She states her daughter is still energetic and playing with her toys and sleeping as usual. She noticed the runny nose 2 days ago which is mostly on the right side, and states that this morning she smelled bad breath and is worried her daughter has an infection.
What do you think?
Foreign obj in the nose
57
what isLeading cause of halitosis in children
nasal foreign body
58
how should we treat children with something up their nose? older and younger child
Vigorous nose blowing if child old enough
Removal by provider
Topical anesthetic ( lidocaine, tetracaine)
Antidecongestant ( pseudophed topical)
Restraint
Alligator forceps through head of otoscope
59
what is the most common pathogen of pharyngitis
viral - entero and adeno
60
what is hand foot and mouth caused by
caused by enterovirus
61
what is pharygoconjunctival caused by
adenovirus
62
what is herpangina pharyngitis caused by
coxackie virus
63
what is onset of viral pharyngitis
gradual
64
what is viral pharyngitis accompanied by?
URI symptoms
65
Ulcers 3mm with halo on ant pillars, soft palate, uvula (not anterior mouth) what is this?
viral pharyn herpangina caused by cox a
66
Ulcers anywhere in the mouth/throat.
| Vesicles, pustules, papules on palms, soles,interdigital, buttocks... what is this?
HFM cox a
67
a pt presents with Fatigue, high fever, exudative pharyngitis, lymphadenopathy (ant & post cervical) splenomegaly, rash.. you do labs and find atypical lymphocytosis and heterophile antibodies ... what is this
Mono EBV
68
what is monospot
test for mono -->heterophile antibodies
69
what causes rash in mono?
pen and amox
70
+IgM for EBV is
definitive test for mono
71
how do you treat mono?
Rest, fever control, steroids if airway obstruction, avoid contact sports if splenomaegaly
72
what is the most common bacterial pharyngitis? 3 names of it
GAS=
Strep pyogenes=
Beta hemolytic strep
73
what has Acute onset, - fever ,headache , nausea (no cough, conjunctivitis, sneezy)
Beefy red throat, tonsillar exudate, petechiae on soft palate, tender cervicle lymph nodes
bacterial pharyngitis
74
what are 2 complications of bact pharyngitis?
rheumatic fever and glomerulonephritis
75
RF may or may not be prevented by eradication of GAS
may
76
glomerulonephritis may or may not be prevented by eradication of GAS
NOT
77
what is sand paper rash in groin and torso and strawberry tongue?
scarlet fever
78
what should you treat strep throat with?
10 PCN V
79
when should you give PCN G IM for strep?
if poor compliance
80
what is the diff bw viral and bacterial pharyngitis
viral has no petichiae or exuadates
81
what happens when antistreptococcal antibodies form immune complexes that cross react cardiac sarcolemma antigens causing inflammatory response in myocardium and valves .
RF
82
what happens when antigen-antibody complexes deposit in glomeruli and incite inflammation and activate the complement system. -->Tea or cola colored urine – gross hematuria
glomerulonephritis
83
what are less serious complications of GAS
OM,peritonsillar abscess, and scarlet fever
84
what is Quinsy
Severe sore throat
High fever
Unilateral
Peritonsillar Abscess
85
how do you treat Peritonsillar Abscess
PCN or Clinda --> rare recurence
86
what happens when GAS invades capsule of tonsil
Peritonsillar Abscess
87
who gets PeritonsillarAbsess more commonly
>10y
88
what abscess invades Nodes that drain adenoids, nasopharynx and paranasal sinuses
Retropharyngeal abscess
89
what age grp are Retropharyngeal abscess common in
<3
90
what presents as Fever, Respiratory symptoms, Neck hyperextension
Dysphoria, drooling, dyspnea
Prominent swelling on one side or pharyngeal wall
Retropharyngeal abscess
91
what is treatment for Retropharyngeal abscess
surgical emergency and IV PCN or clinda
92
what aged kids are likely to get RF and why
5-15 school aged kids more like to to get strep
93
what is Abscess of regional node
| Anterior Cervical node most often
Acute Cervical Adenitis
94
what causes Acute Cervical Adenitis
mostly GAS but staph a also
95
what presents as Neck Pain , dysphagia
| Unilateral red, tender, swollen lymph node, high fever
Acute Cervical Adenitis
96
what 3 circumstances do you get a tonsilectomy and adenoidectomy
-Obstructive sleep apnea -can lead to behavioral problems – sleep study
-Recurrent infections,
-Swallowing disorders, speech abnormalities
hypertrophy
97
what is a short lingual frenulum that can cause feeding problems, speech problems, dental problems
ankyloglossia
98
if tongue cannot _________ refer to ENT
protrude past gums
99
Pt is a 7 yr old male with fever, “pink eye” and now sore throat. On exam you find conjunctivitis, enlarged beefy red tonsills, and cervical lymphadenitis
pharyngoconjunctivitis
100
what is the most common organism of pharyngoconjunctivitis
adenovirus
